Provider Demographics
NPI:1215783139
Name:PERRAULT, SCOTT ALAIN (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ALAIN
Last Name:PERRAULT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 641020
Mailing Address - Street 2:
Mailing Address - City:PULLMAN
Mailing Address - State:WA
Mailing Address - Zip Code:99164
Mailing Address - Country:US
Mailing Address - Phone:425-297-5234
Mailing Address - Fax:
Practice Address - Street 1:PROVIDENCE REGIONAL MEDICAL CENTER EVERETT
Practice Address - Street 2:1700 13TH ST
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201
Practice Address - Country:US
Practice Address - Phone:306-371-9768
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-30
Last Update Date:2025-01-28
Deactivation Date:2025-01-02
Deactivation Code:
Reactivation Date:2025-01-28
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program