Basic Information
| Provider Information | |||||||||
| NPI: | 1801811237 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | VOGT | ||||||||
| FirstName: | VAL | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1325 WOLF PARK DR | ||||||||
| Address2: | STE 103 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012523411 | ||||||||
| FaxNumber: | 9017634305 | ||||||||
| Practice Location | |||||||||
| Address1: | 1325 WOLF PARK DR | ||||||||
| Address2: | STE 102 | ||||||||
| City: | GERMANTOWN | ||||||||
| State: | TN | ||||||||
| PostalCode: | 381381759 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9012523400 | ||||||||
| FaxNumber: | 9017634305 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 12/03/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/03/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VF0040X | 29404 | TN | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Female Pelvic Medicine and Reconstructive Surgery |
ID Information
| ID | Type | State | Issuer | Description | 3816046 | 05 | TN | MEDICAID | 7201891 | 01 | CIGNA | OTHER | 97680 | 01 | AR | BCBS AR | OTHER | 00118962 | 05 | MS | MEDICAID | 4077792 | 01 | TN | BCBS | OTHER | 132782001 | 05 | AR | MEDICAID | P00349905 | 01 | RAILRAOD MEDICARE | OTHER | 5423662 | 01 | AETNA HMO | OTHER |