Provider Demographics
NPI:1811484728
Name:NOMURA, SCOTT
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:NOMURA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12728 19TH AVE SE STE 300
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-6676
Mailing Address - Country:US
Mailing Address - Phone:425-252-1116
Mailing Address - Fax:425-252-1118
Practice Address - Street 1:12728 19TH AVE SE STE 300
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-6676
Practice Address - Country:US
Practice Address - Phone:425-252-1116
Practice Address - Fax:425-252-1118
Is Sole Proprietor?:No
Enumeration Date:2018-04-16
Last Update Date:2024-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA166401207R00000X
WAMD61539589207RC0200X, 207RP1001X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program