Healthcare Provider Details

I. General information

NPI: 1790911576
Provider Name (Legal Business Name): SCOTT ERIC BEVANS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2009
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

316 MARTIN LUTHER KING JR WAY STE 305
TACOMA WA
98405-4260
US

IV. Provider business mailing address

316 MARTIN LUTHER KING JR WAY STE 305
TACOMA WA
98405-4260
US

V. Phone/Fax

Practice location:
  • Phone: 253-403-0065
  • Fax:
Mailing address:
  • Phone: 253-403-0065
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberR4944
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD60443147
License Number StateWA
# 3
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD60443147
License Number StateWA
# 4
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberMD-21894
License Number StateHI
# 5
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD-21894
License Number StateHI
# 6
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number25871
License Number StateNE
# 7
Primary TaxonomyY
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberMD60443147
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: