Healthcare Provider Details

I. General information

NPI: 1427351345
Provider Name (Legal Business Name): SCOTT I BOGGS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2010
Last Update Date: 12/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5221 S HIGHWAY 95 SUITE 10
FORT MOHAVE AZ
86426-9236
US

IV. Provider business mailing address

5221 S HIGHWAY 95 SUITE 10
FORT MOHAVE AZ
86426-9236
US

V. Phone/Fax

Practice location:
  • Phone: 928-788-3668
  • Fax: 928-788-3670
Mailing address:
  • Phone: 928-788-3668
  • Fax: 928-788-3670

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: DR. SCOTT I BOGGS
Title or Position: OWNER
Credential: DPM
Phone: 928-788-3668