Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | 53387 | AZ |
NPI | 1023010964 |
---|---|
Provider Name | Mary P Hogan |
First Address | Prescott, AZ 86301 |
Second Address | Prescott, AZ 86301-1601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 07/12/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
D76498 | (02) | MD |