Basic Information
| Provider Information | |||||||||
| NPI: | 1235109828 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | TIMOTHY | ||||||||
| MiddleName: | J. | ||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5450 FRANTZ RD STE 360 | ||||||||
| Address2: | |||||||||
| City: | DUBLIN | ||||||||
| State: | OH | ||||||||
| PostalCode: | 430164141 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6145446155 | ||||||||
| FaxNumber: | 6145446370 | ||||||||
| Practice Location | |||||||||
| Address1: | 265 W UNION ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ATHENS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 457012313 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405942456 | ||||||||
| FaxNumber: | 7405949630 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/25/2006 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/17/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208D00000X | 34005731 | OH | N | Allopathic & Osteopathic Physicians | General Practice | 207Q00000X | 34005731 | OH | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 5619197341A11 | 01 | OH | BLUECROSS BLUESHIELD | OTHER | 0934341 | 05 | OH | MEDICAID |