Basic Information
| Provider Information | |||||||||
| NPI: | 1205032745 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCROGGINS | ||||||||
| FirstName: | BRENT | ||||||||
| MiddleName: | A | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 525 WESTERN AVE | ||||||||
| Address2: | SUITE 302 | ||||||||
| City: | CONWAY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 720344967 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013285515 | ||||||||
| FaxNumber: | 5017454651 | ||||||||
| Practice Location | |||||||||
| Address1: | 1711 E HARDING ST | ||||||||
| Address2: | |||||||||
| City: | MORRILTON | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721104507 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013544637 | ||||||||
| FaxNumber: | 5015525326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/22/2007 | ||||||||
| LastUpdateDate: | 11/07/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | E-5825 | AR | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.