Provider Demographics
NPI:1205891637
Name:CHAFFIN, SCOTT J (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:J
Last Name:CHAFFIN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 POTTERY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3711
Mailing Address - Country:US
Mailing Address - Phone:360-895-5000
Mailing Address - Fax:360-895-5034
Practice Address - Street 1:10030 SW 210TH ST
Practice Address - Street 2:
Practice Address - City:VASHON
Practice Address - State:WA
Practice Address - Zip Code:98070-6584
Practice Address - Country:US
Practice Address - Phone:206-463-3671
Practice Address - Fax:206-463-3613
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1226204D00000X, 207Q00000X
WAOP00002175207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO88677079Medicaid
WA2017265Medicaid
CO88677079Medicaid