Provider Demographics
NPI:1760417182
Name:WHITTAKER, SCOTT BERNARD (LMP, RC)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:BERNARD
Last Name:WHITTAKER
Suffix:
Gender:M
Credentials:LMP, RC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 10930
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-0930
Mailing Address - Country:US
Mailing Address - Phone:206-852-2572
Mailing Address - Fax:
Practice Address - Street 1:262 WINSLOW WAY E
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2430
Practice Address - Country:US
Practice Address - Phone:206-852-2572
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00018246174400000X
WARC00047268174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist