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1003881608

NPI Code Detail

MEDICARE: DR. JOHN W SCROGGINS MD

MEDICARE: DR. JOHN W SCROGGINS 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	207Q00000X	Family Medicine Physician	F1239	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	752616977118	OTHER	TX	TRICARE
4	75-2616977-042	OTHER	TX	TRICARE
5	8DC106	OTHER	TX	BCBS
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1003881608
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN W SCROGGINS MD

Provider Business Mailing Address
First Line	:	PO BOX 846098
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75284-6098
Country	:	US
Telephone Number	:	903-324-6450
Fax Number	:

Provider Business Practice Location Address
First Line	:	8288 S BROADWAY AVE
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75703-5262
Country	:	US
Telephone Number	:	903-606-7060
Fax Number	:

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	10/14/2014

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Directions to “ DR. JOHN W SCROGGINS MD” Practice Location

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