Healthcare Provider Details

I. General information

NPI: 1063525723
Provider Name (Legal Business Name): SCOTT PAUL CUDA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVENU
TACOMA WA
98431-7282
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CENTER BLDG 9040A
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-2300
  • Fax:
Mailing address:
  • Phone: 253-968-2300
  • Fax: 253-968-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number13103
License Number StateHI
# 2
Primary TaxonomyN
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number062671
License Number StateGA
# 3
Primary TaxonomyY
Taxonomy Code2088P0231X
TaxonomyPediatric Urology Physician
License Number60212116
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: