Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207SG0201X | Clinical Genetics (M.D.) | 01063158A | IN |
N | 208000000X | Pediatrician | 01063158A | IN |
NPI | 1720206022 |
---|---|
Provider Name | Dr. Jacob Hogue |
First Address | Tacoma, WA 98431-0001 |
Second Address | Tacoma, WA 98431-1100 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 23/04/2007 |
Last Update Date | 04/03/2019 |