MEDICARE: DR. SCOTT IRWIN BOGGS DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	0417	AZ
2	213ES0103X	Foot & Ankle Surgery Podiatrist	E3499	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	000E34990	OTHER	CA	BLUE SHIELD
2	AZ0194650	OTHER	AZ	BLUE CROSS BLUE SHIELD
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467439331
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SCOTT IRWIN BOGGS DPM

Provider Business Mailing Address
First Line	:	5221 HWY 95
Second Line	:	SUITE 10
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9244
Country	:	US
Telephone Number	:	928-788-3668
Fax Number	:	928-788-3670

Provider Business Practice Location Address
First Line	:	5221 HWY 95
Second Line	:	SUITE 10
City	:	FORT MOHAVE
State	:	AZ
Zip	:	86426-9244
Country	:	US
Telephone Number	:	928-788-3668
Fax Number	:	928-788-3670

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

Provider Enumeration Date	:	12/30/2005
Last Update Date	:	07/07/2020

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