1558772558 NPI number — DR. DARREN THOMAS SCOGGIN M.D.

Table of content: DR. DARREN THOMAS SCOGGIN M.D. (NPI 1558772558)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558772558 NPI number — DR. DARREN THOMAS SCOGGIN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SCOGGIN
Provider First Name:
DARREN
Provider Middle Name:
THOMAS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1558772558
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/28/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1867 CRANE RIDGE DRIVE
Provider Second Line Business Mailing Address:
SUITE 101B
Provider Business Mailing Address City Name:
JACKSON
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39216
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-362-8776
Provider Business Mailing Address Fax Number:
601-354-8786

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1867 CRANE RIDGE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 101B
Provider Business Practice Location Address City Name:
JACKSON
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
603-362-8776
Provider Business Practice Location Address Fax Number:
601-354-8786
Provider Enumeration Date:
05/13/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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