Basic Information
| Provider Information | |||||||||
| NPI: | 1730299637 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HOGAN | ||||||||
| FirstName: | PETER | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 N CENTRAL AVE | ||||||||
| Address2: | SUITE 900 | ||||||||
| City: | PHOENIX | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 850122425 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6024063729 | ||||||||
| FaxNumber: | 6027989412 | ||||||||
| Practice Location | |||||||||
| Address1: | 1727 W FRYE RD STE 210 | ||||||||
| Address2: | |||||||||
| City: | CHANDLER | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 852245298 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4807287564 | ||||||||
| FaxNumber: | 4807282253 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2006 | ||||||||
| LastUpdateDate: | 07/22/2019 | ||||||||
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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 | 22821 | AZ | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 365024 | 05 | AZ | MEDICAID |