Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | MD24224 | ME |
N | 207X00000X | Orthopaedic Surgeon | P7281 | TX |
Y | 207XP3100X | Pediatric Orthopaedic Surgeon | 282195 | MA |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | P7281 | TX |
NPI | 1619107349 |
---|---|
Provider Name | Grant Douglas Hogue |
First Address | Boston, MA 02115-5724 |
Second Address | Boston, MA 02115-5724 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/07/2009 |
Last Update Date | 05/02/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
346981901 | (05) | TX |