Provider Demographics
NPI:1447314570
Name:MCCREADIE, G. SCOTT (MD)
Entity type:Individual
Prefix:DR
First Name:G.
Middle Name:SCOTT
Last Name:MCCREADIE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GORDON
Other - Middle Name:SCOTT
Other - Last Name:MCCREADIE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:6321 VERDA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-7794
Mailing Address - Country:US
Mailing Address - Phone:425-445-4669
Mailing Address - Fax:
Practice Address - Street 1:SKY LAKES MEDICAL CENTER
Practice Address - Street 2:2865 DAGGETT AVE
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97601
Practice Address - Country:US
Practice Address - Phone:541-882-6311
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10105571-8905207P00000X
WA37052207P00000X
NV15043207P00000X
OR182254207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8242513Medicaid
WA8242513Medicaid
WAH00013Medicare UPIN