MEDICARE: DR. JAN WRIGHT SCRUGGS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	C4858	AR

General Provider Information

NPI Number	:	1982657169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAN WRIGHT SCRUGGS MD

Provider Business Mailing Address
First Line	:	3401 SPRINGHILL DRIVE
Second Line	:	SUITE 250
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2926
Country	:	US
Telephone Number	:	501-758-7627
Fax Number	:	501-758-9499

Provider Business Practice Location Address
First Line	:	3401 SPRINGHILL DRIVE
Second Line	:	SUITE 250
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72117-2926
Country	:	US
Telephone Number	:	501-758-7627
Fax Number	:	501-758-9499

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2006
Last Update Date	:	07/08/2007

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