Provider Demographics
NPI:1821247560
Name:RIKKI J. SCOGGIN, M.D., PLLC
Entity Type:Organization
Organization Name:RIKKI J. SCOGGIN, M.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:RIKKI
Authorized Official - Middle Name:J
Authorized Official - Last Name:SCOGGIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-626-5535
Mailing Address - Street 1:457 LANDA STREET
Mailing Address - Street 2:STE. C
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78130
Mailing Address - Country:US
Mailing Address - Phone:830-626-5535
Mailing Address - Fax:830-626-5519
Practice Address - Street 1:457 LANDA ST
Practice Address - Street 2:STE. C
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78130-5417
Practice Address - Country:US
Practice Address - Phone:830-626-5535
Practice Address - Fax:830-626-5519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H22030Medicare UPIN