Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207V00000X | Obstetrician & Gynecologist | A35569 | CA |
NPI | 1013939875 |
---|---|
Provider Name | Roger Bruce Scarborough |
First Address | Napa, CA 94558-2908 |
Second Address | Napa, CA 94558-2908 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 10/11/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A28737 | (02) | |
GR0081500 | (05) | CA |
GR0081501 | MEDI-CAL (01) | CA |