Provider Demographics
NPI:1003841958
Name:ELLOWAY, RICHARD SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:SCOTT
Last Name:ELLOWAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:RICHARD
Other - Middle Name:S
Other - Last Name:ELLOWAY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1657 VIEW POINT CT SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-6357
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:209 LILLY RD NE STE B
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5030
Practice Address - Country:US
Practice Address - Phone:360-413-8250
Practice Address - Fax:360-413-8830
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00029202207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA911639821OtherTAX ID
WA100005752OtherRR MEDICARE
WA58585OtherL&I WORKERS COMP
WAD20530OtherPACC
WAEL5942OtherBL CROSS BL SHIELD
WA1086933Medicaid
WA333154001OtherGROUP HEALTH
WAF28655Medicare UPIN
WA100005752Medicare ID - Type UnspecifiedRR MEDICARE
115000055Medicare PIN
WA911639821OtherTAX ID