Basic Information
| Provider Information | |||||||||
| NPI: | 1649230095 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BONVALLET | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | T | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 5845 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972285845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254545281 | ||||||||
| FaxNumber: | 4259905261 | ||||||||
| Practice Location | |||||||||
| Address1: | 1100 112TH AVE NE | ||||||||
| Address2: | SUITE 320 | ||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980044511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4252893000 | ||||||||
| FaxNumber: | 4252893240 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2006 | ||||||||
| LastUpdateDate: | 07/12/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | MD00030620 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | MD00030620 | WA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | 207RS0012X | MD00030620 | WA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine |
No ID Information.