Provider Demographics
NPI:1538101779
Name:SCRUGGS, ROBERT PICKETT III (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PICKETT
Last Name:SCRUGGS
Suffix:III
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 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-437-9605
Practice Address - Street 1:3410 WORTH ST
Practice Address - Street 2:DEPARTMENT OF RADIATION ONCOLOGY
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-2003
Practice Address - Country:US
Practice Address - Phone:214-370-1400
Practice Address - Fax:214-370-1405
Is Sole Proprietor?:No
Enumeration Date:2006-06-12
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD76762085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX138575902Medicaid
TX138575910Medicaid
TX138575908Medicaid
TX138575913Medicaid
TX8R1545OtherBLUE CROSS OF TEXAS
NM000J9444Medicaid
TX8L10935Medicare PIN
TX138575910Medicaid
NM000J9444Medicaid
TXTXB130718Medicare PIN
TX87888KMedicare PIN
TX89R233Medicare PIN
TX138575908Medicaid