Provider Demographics
NPI:1023004991
Name:HOGAN, WILLIAM R (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5315 DELHI AVE
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45238-5214
Mailing Address - Country:US
Mailing Address - Phone:513-922-2335
Mailing Address - Fax:513-922-4454
Practice Address - Street 1:5315 DELHI AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45238-5214
Practice Address - Country:US
Practice Address - Phone:513-922-2335
Practice Address - Fax:513-922-4454
Is Sole Proprietor?:No
Enumeration Date:2005-09-26
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1707213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000012371OtherBLUE CROSS/BLUE SHIELD
OH0318043Medicaid
OH27-00262OtherEVERCARE,UNITEDHELATHCARE
OH311164051 00OtherWORKERS COMPENSATION
OH1287600001OtherMEDICARE DURABLE ID NUMBE
OH27000546OtherUNITED HEALTHCARE
OH648840OtherAETNA
OH648840OtherAETNA
OH311164051 00OtherWORKERS COMPENSATION