Healthcare Provider Details

I. General information

NPI: 1699771014
Provider Name (Legal Business Name): SCOTT C SCOGGINS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2005
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13880 SHELL POINT PLZ STE 110
FORT MYERS FL
33908-3504
US

IV. Provider business mailing address

15000 SHELL POINT BLVD STE 100
FORT MYERS FL
33908-1657
US

V. Phone/Fax

Practice location:
  • Phone: 239-454-2146
  • Fax:
Mailing address:
  • Phone: 239-454-2146
  • Fax: 239-466-2111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9501407
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberME168847
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: