Basic Information
Provider Information
NPI: 1932281656
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: VOGEL
FirstName: WILLIAM
MiddleName:  
NamePrefix: MR.
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1292 HIGH ST STE 224
Address2:  
City: EUGENE
State: OR
PostalCode: 974013238
CountryCode: US
TelephoneNumber: 5415002500
FaxNumber:  
Practice Location
Address1: 1445 GATEWAY BLVD
Address2:  
City: COTTAGE GROVE
State: OR
PostalCode: 974241224
CountryCode: US
TelephoneNumber: 5416407625
FaxNumber:  
Other Information
ProviderEnumerationDate: 10/20/2006
LastUpdateDate: 01/24/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 01/24/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000XPA00462ORY Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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