Healthcare Provider Details

I. General information

NPI: 1669767828
Provider Name (Legal Business Name): SCOTT GERMANN L.M.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/16/2011
Last Update Date: 06/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15410 NE 85TH STREET
VANCOUVER WA
98682
US

IV. Provider business mailing address

15410 NE 85TH ST
VANCOUVER WA
98682-9485
US

V. Phone/Fax

Practice location:
  • Phone: 360-604-2126
  • Fax:
Mailing address:
  • Phone: 360-604-2126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171W00000X
TaxonomyContractor
License NumberMA 00014184
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: