Provider Demographics
NPI:1972704237
Name:ROBERT L SCOTT MD INC PS
Entity type:Organization
Organization Name:ROBERT L SCOTT MD INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER MD
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-457-4761
Mailing Address - Street 1:814 S PEABODY ST
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-7906
Mailing Address - Country:US
Mailing Address - Phone:360-457-4761
Mailing Address - Fax:360-457-1744
Practice Address - Street 1:814 S PEABODY ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-7906
Practice Address - Country:US
Practice Address - Phone:360-457-4761
Practice Address - Fax:360-457-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00023380174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA114164OtherL&I PROVIDER NUMBER
WA1019447Medicaid
WA=========OtherREGENCE PROVIDER NUMBER
WA=========OtherBLUE CROSS PROVIDER NUMBE
WA=========OtherREGENCE PROVIDER NUMBER
WAA06146Medicare UPIN