Provider Demographics
NPI:1033310669
Name:JOSEPH M SCOGGIN MD PLLC
Entity Type:Organization
Organization Name:JOSEPH M SCOGGIN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-343-1141
Mailing Address - Street 1:2905 W WARNER RD
Mailing Address - Street 2:STE 19
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85224-1674
Mailing Address - Country:US
Mailing Address - Phone:480-219-1965
Mailing Address - Fax:480-248-7772
Practice Address - Street 1:2905 W WARNER RD
Practice Address - Street 2:STE 19
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85224-1674
Practice Address - Country:US
Practice Address - Phone:480-219-1965
Practice Address - Fax:480-248-7772
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-30
Last Update Date:2009-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ30290174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ791196Medicaid
AZ5624510001Medicare NSC
AZZ106767Medicare PIN
AZG26900Medicare UPIN