Provider Demographics
NPI:1013939875
Name:SCARBOROUGH, ROGER BRUCE (MD)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:BRUCE
Last Name:SCARBOROUGH
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 1:1100 TRANCAS STREET
Mailing Address - Street 2:STE 209
Mailing Address - City:NAPA
Mailing Address - State:CA
Mailing Address - Zip Code:94558-2908
Mailing Address - Country:US
Mailing Address - Phone:707-251-1850
Mailing Address - Fax:707-226-1502
Practice Address - Street 1:1100 TRANCAS STREET
Practice Address - Street 2:STE 209
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-2908
Practice Address - Country:US
Practice Address - Phone:707-251-1850
Practice Address - Fax:707-226-1502
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35569207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0081501OtherMEDI-CAL
CAGR0081500Medicaid
CAGR0081501OtherMEDI-CAL
CAZZZ149732Medicare ID - Type Unspecified
CADK405ZMedicare PIN