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NPI Code Detail

MEDICARE: GRANT SCULL MD

MEDICARE: GRANT SCULL MD
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
1207Q00000XFamily Medicine PhysicianMD00038782WA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1750372397
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRANT SCULL MD
Provider Business Mailing Address
First Line : 125 16TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-5211
Country : US
Telephone Number : 206-326-3530
Fax Number :
Provider Business Practice Location Address
First Line : 125 16TH AVE E
Second Line :
City : SEATTLE
State : WA
Zip : 98112-5211
Country : US
Telephone Number : 206-326-3530
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 05/03/2021

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