MEDICARE: JERRY L SCRUGGS 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	207L00000X	Anesthesiology Physician	MD15498	TN

General Provider Information

NPI Number	:	1639332349
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JERRY L SCRUGGS MD

Provider Business Mailing Address
First Line	:	5954 BRIERHEDGE AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2328
Country	:	US
Telephone Number	:	901-685-7838
Fax Number	:

Provider Business Practice Location Address
First Line	:	5954 BRIERHEDGE AVE
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38120-2328
Country	:	US
Telephone Number	:	901-685-7838
Fax Number	:

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

Provider Enumeration Date	:	07/03/2008
Last Update Date	:	07/03/2008

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