Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0200X | Critical Care Medicine | M12864 | ID |
Y | 207RP1001X | Pulmonary Disease | M12864 | ID |
NPI | 1083728430 |
---|---|
Provider Name | Dr. Robert Scoggins |
First Address | Coeur D Alene, ID 83814-4401 |
Second Address | Coeur D Alene, ID 83814-4401 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/08/2006 |
Last Update Date | 27/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1932464989 | (05) | ID |