Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | ||
Y | 222Z00000X | Podiatrist | ||
N | 224P00000X | Prosthetist |
NPI | 1164811097 |
---|---|
Provider Name | Mr. Matthew Steven Scoggin |
First Address | Raleigh, NC 27615-4731 |
Second Address | Raleigh, NC 27615-4731 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 17/07/2019 |