Individual
SCOT BACON ATHAIR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LPM
Contact information
Practice address
1111 E FRONT ST, PORT ANGELES, WA 98362-4307
(360) 452-3017
Mailing address
1111 E FRONT ST, PORT ANGELES, WA 98362-4307
(360) 452-3017
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MA00004385
WA
Other
Enumeration date
12/15/2007
Last updated
12/15/2007
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