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General NPI Number Information
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NPI Number | 1205939428
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Entity Type | Individual
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Provider Name | ANTHONY SCROGGINS D.P.M.
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Gender | Male
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Dates
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Enumeration Date | 09/06/2006
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Last Update Date | 06/22/2009
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Provider Practice Location Address
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Address Line | 1515 W WALNUT ST SUITE 3B
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1150
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Country | US
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Telephone | 217-245-4610
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Fax | 217-479-0169
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Provider Business Mailing Address
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Address Line | 1515 W WALNUT ST SUITE 3B
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City | JACKSONVILLE
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State | IL
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Zip | 62650-1150
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Country | US
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Telephone | 217-245-4610
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Fax | 217-479-0169
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213E00000X
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Taxonomy Name | Podiatrist
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License Number | 016004976
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License Number State | IL
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