Provider Demographics
NPI:1346249638
Name:SCROGGS, MATTHEW GARY (MD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:GARY
Last Name:SCROGGS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 122534 DEPT 2534
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75312-2534
Mailing Address - Country:US
Mailing Address - Phone:337-494-2921
Mailing Address - Fax:337-494-6523
Practice Address - Street 1:1890 W GAUTHIER RD STE 140
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7179
Practice Address - Country:US
Practice Address - Phone:337-480-5570
Practice Address - Fax:337-480-5581
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14504R207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1122530Medicaid
LAMD.14504ROtherSTATE MEDICAL LICENSE
LA1122530Medicaid