Provider Demographics
NPI:1780611871
Name:LINDQUIST, SCOTT WAYNE (MD MPH)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:WAYNE
Last Name:LINDQUIST
Suffix:
Gender:M
Credentials:MD MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32020 LITTLE BOSTON RD NE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:WA
Mailing Address - Zip Code:98346-9734
Mailing Address - Country:US
Mailing Address - Phone:360-297-9649
Mailing Address - Fax:360-297-9614
Practice Address - Street 1:32014 LITTLE BOSTON RD NE
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:WA
Practice Address - Zip Code:98346-9734
Practice Address - Country:US
Practice Address - Phone:360-297-2840
Practice Address - Fax:360-297-7052
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00033520174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012763Medicaid
WA5163LIOtherREGENCE RIDER#
WA910875163-39OtherKPS ID#
WA910875163-39OtherKPS ID#
WA5163LIOtherREGENCE RIDER#