MEDICARE: DR. JOHN SCOTT BOGGS M.D.

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	174400000X	Specialist	ME0020523	FL

General Provider Information

NPI Number	:	1063596138
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN SCOTT BOGGS M.D.

Provider Business Mailing Address
First Line	:	1820 BARRS ST.
Second Line	:	SUITE 104
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4716
Country	:	US
Telephone Number	:	904-388-5391
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 BARRS ST
Second Line	:	SUITE 104
City	:	JACKSONVILLE
State	:	FL
Zip	:	32204-4742
Country	:	US
Telephone Number	:	904-388-5391
Fax Number	:

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

Provider Enumeration Date	:	10/25/2006
Last Update Date	:	07/08/2007

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