Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | 096.003557 | IL |
Y | 213ES0000X | Sports Medicine | 096.003557 | IL |
NPI | 1326466590 |
---|---|
Provider Name | Chelsea Hoggard |
First Address | Poplar Bluff, MO 63901-2346 |
Second Address | Poplar Bluff, MO 63901-2346 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/04/2014 |
Last Update Date | 27/03/2017 |