Provider Demographics
NPI:1205032745
Name:SCROGGINS, BRENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENT
Middle Name:A
Last Name:SCROGGINS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:525 WESTERN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:CONWAY
Mailing Address - State:AR
Mailing Address - Zip Code:72034-4967
Mailing Address - Country:US
Mailing Address - Phone:501-328-5515
Mailing Address - Fax:501-745-4651
Practice Address - Street 1:1711 E HARDING ST
Practice Address - Street 2:
Practice Address - City:MORRILTON
Practice Address - State:AR
Practice Address - Zip Code:72110-4507
Practice Address - Country:US
Practice Address - Phone:501-354-4637
Practice Address - Fax:501-552-5326
Is Sole Proprietor?:No
Enumeration Date:2007-06-22
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE-5825207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine