Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 4301114021 | MI |
Y | 207X00000X | Orthopaedic Surgeon | MD60964056 | WA |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | MD60964056 | WA |
NPI | 1326481797 |
---|---|
Provider Name | Gregory L Scallon |
First Address | Richland, WA 99352-9532 |
Second Address | Richland, WA 99352 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2013 |
Last Update Date | 25/03/2021 |