Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | 13026 | TX |
NPI | 1043285109 |
---|---|
Provider Name | Dr. Charles Keener Scruggs |
First Address | Texas City, TX 77590-7069 |
Second Address | Texas City, TX 77590-7069 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/02/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T15812 | (02) | TX |