Healthcare Provider Details

I. General information

NPI: 1588785141
Provider Name (Legal Business Name): STEVE GLEN SCOTT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2007
Last Update Date: 06/01/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 2ND AVE RM 3116
SEATTLE WA
98174-1009
US

IV. Provider business mailing address

3301 S DAY ST
SEATTLE WA
98144-4010
US

V. Phone/Fax

Practice location:
  • Phone: 206-220-4795
  • Fax:
Mailing address:
  • Phone: 206-328-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberMD00039829
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: