Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | AT5169 | TX |
Y | 213ES0000X | Sports Medicine | AT5169 | TX |
NPI | 1043802614 |
---|---|
Provider Name | Johanna Elizabeth Hogan |
First Address | Frisco, TX 75035-9367 |
Second Address | Frisco, TX 75035-9367 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/02/2021 |
Last Update Date | 05/02/2021 |