Provider Demographics
NPI:1699771014
Name:SCOGGINS, SCOTT C (MD)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:C
Last Name:SCOGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15000 SHELL POINT BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-1657
Mailing Address - Country:US
Mailing Address - Phone:239-454-2146
Mailing Address - Fax:239-466-2111
Practice Address - Street 1:13880 SHELL POINT PLZ STE 110
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-3504
Practice Address - Country:US
Practice Address - Phone:239-454-2146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9501407207Q00000X
FLME168847207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC2231534FOtherMEDICARE INDIVIDUAL ID
NC8910292Medicaid
NC2231534FOtherMEDICARE INDIVIDUAL ID
NCG32868Medicare UPIN
NC8910292Medicaid