Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 09134 | MS |
NPI | 1023006293 |
---|---|
Provider Name | Reed B Hogan |
First Address | Flowood, MS 39232-9513 |
Second Address | Flowood, MS 39232-9513 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 20/09/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00115723 | (05) | MS |
B31031 | (02) | MS |