Provider Demographics
NPI:1952425308
Name:PAUKER, SCOTT GREGORY (LMP)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:GREGORY
Last Name:PAUKER
Suffix:
Gender:M
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:309 16TH AVE E
Mailing Address - Street 2:#303
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112
Mailing Address - Country:US
Mailing Address - Phone:206-349-4987
Mailing Address - Fax:
Practice Address - Street 1:3221 EASTLAKE AVE E
Practice Address - Street 2:STE 110
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102
Practice Address - Country:US
Practice Address - Phone:206-349-4987
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021742225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist