MEDICARE: JERRY WAYNE SCOTT III PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA61501433	WA
2	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1346824703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY WAYNE SCOTT III PA-C

Provider Business Mailing Address
First Line	:	MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-0001
Country	:	US
Telephone Number	:	253-968-2252
Fax Number	:

Provider Business Practice Location Address
First Line	:	MADIGAN ARMY MEDICAL CENTER 9040 JACKSON AVE
Second Line	:
City	:	TACOMA
State	:	WA
Zip	:	98431-5318
Country	:	US
Telephone Number	:	253-968-2252
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2021
Last Update Date	:	09/27/2024

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