Provider Demographics
NPI:1598896417
Name:SCRUGGS, GRANGER RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:GRANGER
Middle Name:RYAN
Last Name:SCRUGGS
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: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:
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:2007-03-09
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM59162085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX187083401Medicaid
TX8W4994OtherBCBSTX
TX187083403Medicaid
TXP00470996Medicare PIN
TX8W4994OtherBCBSTX
TX8J6270Medicare PIN