Provider Demographics
NPI:1689037129
Name:SCOGGINS, TINA (DO)
Entity Type:Individual
Prefix:DR
First Name:TINA
Middle Name:
Last Name:SCOGGINS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:ASHTON
Mailing Address - State:ID
Mailing Address - Zip Code:83420-5211
Mailing Address - Country:US
Mailing Address - Phone:208-652-3396
Mailing Address - Fax:208-652-7924
Practice Address - Street 1:23 S 8TH ST
Practice Address - Street 2:
Practice Address - City:ASHTON
Practice Address - State:ID
Practice Address - Zip Code:83420-5211
Practice Address - Country:US
Practice Address - Phone:208-652-3396
Practice Address - Fax:208-652-7924
Is Sole Proprietor?:No
Enumeration Date:2016-04-01
Last Update Date:2020-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
IDO-1294207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program