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NPI Code Detail

MEDICARE: MR. GARY SCRUGGS JR.

MEDICARE: MR. GARY SCRUGGS JR.
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
1106S00000XBehavior TechnicianBACB611940TX

General Provider Information

NPI Number : 1497561849
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. GARY SCRUGGS JR.
Provider Business Mailing Address
First Line : 5234 WILD HORSE CT
Second Line :
City : ARLINGTON
State : TX
Zip : 76017-2075
Country : US
Telephone Number : 972-533-7281
Fax Number :
Provider Business Practice Location Address
First Line : 209 BILLINGS ST
Second Line :
City : ARLINGTON
State : TX
Zip : 76010-2474
Country : US
Telephone Number : 817-592-5665
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/09/2024
Last Update Date : 12/09/2024

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Directions to “ MR. GARY SCRUGGS JR. ” Practice Location

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