Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 2086S0102X | Surgical Critical Care | 2012021382 | MO |
N | 2086S0127X | Trauma Surgeon | 200000607 | NC |
N | 2086S0127X | Trauma Surgeon | 2012021382 | MO |
Y | 2086S0127X | Trauma Surgeon | R4136 | TX |
NPI | 1437147865 |
---|---|
Provider Name | Dr. Scott G Sagraves |
First Address | Dallas, TX 75284-4658 |
Second Address | Temple, TX 76508-2640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/10/2005 |
Last Update Date | 13/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
126GT | BCBS NC (01) | NC |
89126GT | (05) | NC |
990015449 | RAILROAD MEDICARE (01) | NC |
G96911 | (02) | NC |