Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD60459476 | WA |
N | 111NI0900X | Internist | MD60459476 | WA |
N | 207RH0000X | Hematologist | MD60459476 | WA |
Y | 207RH0003X | Hematology & Oncology | MD60459476 | WA |
NPI | 1063703809 |
---|---|
Provider Name | Scott Michael Letellier |
First Address | Vancouver, WA 98683-8004 |
Second Address | Bellingham, WA 98225-1919 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/04/2011 |
Last Update Date | 20/02/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
09028051 | (05) | MS |