Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | MD00035266 | WA |
NPI | 1194822874 |
---|---|
Provider Name | Amaryllis J. Scott |
First Address | Spokane, WA 99218-1257 |
Second Address | Spokane, WA 99218-1257 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2006 |
Last Update Date | 28/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8209850 | (05) | WA |
G09902 | (02) | WA |