Basic Information
| Provider Information | |||||||||
| NPI: | 1104347640 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | ANGELA | ||||||||
| MiddleName: | BROOKE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1000 HOUSTON ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | FT WORTH | ||||||||
| State: | TX | ||||||||
| PostalCode: | 761026415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8173360551 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1200 CHILDRENS AVE | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731044637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4052714412 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2017 | ||||||||
| LastUpdateDate: | 11/21/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA11339 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.