MEDICARE: PAUL MICHAEL SCOTT DPM

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	PO00000816	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0223172	OTHER	WA	STATE L&I
2	0224379	OTHER	WA	STATE L&I
3	0237067	OTHER	WA	STATE L&I
4	8945569	OTHER	WA	STATE CRIME VICTIMS
5	P00447141	OTHER	WA	RAILROAD
6	0222100	OTHER	WA	STATE L&I
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598970675
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL MICHAEL SCOTT DPM

Provider Business Mailing Address
First Line	:	1708 S YAKIMA AVE
Second Line	:	STE 110
City	:	TACOMA
State	:	WA
Zip	:	98405-5300
Country	:	US
Telephone Number	:	253-627-9151
Fax Number	:	253-591-8892

Provider Business Practice Location Address
First Line	:	1708 S YAKIMA AVE
Second Line	:	STE 110
City	:	TACOMA
State	:	WA
Zip	:	98405-5300
Country	:	US
Telephone Number	:	253-627-9151
Fax Number	:	253-591-8892

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2007
Last Update Date	:	11/12/2010

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