Basic Information
| Provider Information | |||||||||
| NPI: | 1578082814 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | HOGAN MEDICAL CLINIC LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6966 S UTICA AVE STE 225 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741363903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9184926333 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 E TERRI DR | ||||||||
| Address2: | |||||||||
| City: | VALLIANT | ||||||||
| State: | OK | ||||||||
| PostalCode: | 747646801 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9186892500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/19/2017 | ||||||||
| LastUpdateDate: | 09/19/2017 | ||||||||
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| AuthorizedOfficialLastName: | HOGAN | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9186892500 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.