Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0210X | Pediatric Nephrologist | 34092 | AZ |
NPI | 1760591820 |
---|---|
Provider Name | Ronald J Hogg |
First Address | Phoenix, AZ 85012-2425 |
Second Address | Phoenix, AZ 85013-4419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
939514 | (05) | AZ |
C17010 | (02) | AZ |