Provider Demographics
NPI:1801970660
Name:ANDREW, JOHN SCOTT (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:SCOTT
Last Name:ANDREW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15214 CANYON RD E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-7472
Mailing Address - Country:US
Mailing Address - Phone:253-539-4200
Mailing Address - Fax:253-539-6025
Practice Address - Street 1:15214 CANYON RD E
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98375-7472
Practice Address - Country:US
Practice Address - Phone:253-539-4200
Practice Address - Fax:253-539-6025
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00025582207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0227517OtherLIWA
WA605960013OtherUSDLAB
WA8110488Medicaid
WAAN5002OtherBSWA
WA1450ANOtherBSWA
WAG8907495OtherMEDICARE
WA0291718OtherL&I
WA0291720OtherL&I
WAAN5002OtherBSWA
C82609Medicare UPIN
WA080065003Medicare PIN
WA8110488Medicaid