Individual
SCOTT MICHAEL ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1500 CONTINENTAL PL, MOUNT VERNON, WA 98273-4105
(360) 424-7041
Mailing address
1401 S LAVENTURE RD, MOUNT VERNON, WA 98274-6033
(360) 424-7041
(425) 339-8273
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
PA60198949
WA
363AS0400X
Surgical Physician Assistant
Primary
PA60198949
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2012072
—
WA
Enumeration date
04/05/2011
Last updated
10/20/2021
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