Healthcare Provider Details

I. General information

NPI: 1083728430
Provider Name (Legal Business Name): ROBERT SCOGGINS M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2006
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W IRONWOOD DR STE 378
COEUR D ALENE ID
83814-4401
US

IV. Provider business mailing address

700 W IRONWOOD DR STE 378
COEUR D ALENE ID
83814-4401
US

V. Phone/Fax

Practice location:
  • Phone: 208-765-1252
  • Fax: 208-765-1494
Mailing address:
  • Phone: 208-765-1252
  • Fax: 208-765-1494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License NumberM12864
License Number StateID
# 2
Primary TaxonomyY
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License NumberM12864
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: