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General NPI Number Information
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NPI Number | 1013022425
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Entity Type | Individual
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Provider Name | SCOTT KEOLA MIYAKE M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/19/2006
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Last Update Date | 02/04/2022
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Provider Practice Location Address
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Address Line | 6902 SE LAKE RD STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97267-2148
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Country | US
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Telephone | 503-786-1167
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Fax | 503-786-1153
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Provider Business Mailing Address
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Address Line | 6902 SE LAKE RD STE 100
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City | MILWAUKIE
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State | OR
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Zip | 97267-2148
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Country | US
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Telephone | 503-786-1167
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Fax | 503-786-1153
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD00045274
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 207RN0300X
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Taxonomy Name | Nephrology Physician
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License Number | MD24235
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License Number State | OR
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