Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 14840 | NH |
N | 207X00000X | Orthopaedic Surgeon | ME103929 | FL |
N | 207XP3100X | Pediatric Orthopaedic Surgeon | 4301083570 | MI |
NPI | 1205046992 |
---|---|
Provider Name | Jeremy P Hogan |
First Address | Wolfeboro, NH 03894-4411 |
Second Address | Wolfeboro, NH 03894-4411 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/05/2007 |
Last Update Date | 21/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000886300 | (05) | FL |
30366 | BCBS (01) | FL |
4131100 | CIGNA (01) | FL |
4301083570 | (02) | MI |
9070299 | AENTA (01) | FL |