Provider Demographics
NPI:1790911576
Name:BEVANS, SCOTT ERIC (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:ERIC
Last Name:BEVANS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 MARTIN LUTHER KING JR WAY STE 305
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4260
Mailing Address - Country:US
Mailing Address - Phone:253-403-0065
Mailing Address - Fax:
Practice Address - Street 1:316 MARTIN LUTHER KING JR WAY STE 305
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4260
Practice Address - Country:US
Practice Address - Phone:253-403-0065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-07
Last Update Date:2025-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR4944207YS0123X
WAMD60443147207YS0123X, 207Y00000X, 2082S0099X
HIMD-21894207YS0123X, 2082S0099X
NE25871208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2082S0099XAllopathic & Osteopathic PhysiciansPlastic SurgeryPlastic Surgery Within the Head and Neck
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice