Provider Demographics
NPI:1861594384
Name:BILDSTEN, SCOTT A (DO)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:A
Last Name:BILDSTEN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 SW SEDGWICK RD STE 220
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98367-6447
Mailing Address - Country:US
Mailing Address - Phone:360-874-7300
Mailing Address - Fax:360-874-7319
Practice Address - Street 1:451 SW SEDGWICK RD STE 220
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98367-6447
Practice Address - Country:US
Practice Address - Phone:360-874-7300
Practice Address - Fax:360-874-7319
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP00001711208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0264450OtherSTATE L&I
WA0264427OtherSTATE L&I
WA0264446OtherSTATE L&I
WA0291738OtherSTATE L&I
WAGAB18639Medicare PIN
WA0264427OtherSTATE L&I
WAG8892852Medicare PIN