Provider Demographics
NPI:1023209228
Name:HOGAN, PATRICK WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:WILLIAM
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:20280 N 59TH AVE
Mailing Address - Street 2:STE 115-617
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6850
Mailing Address - Country:US
Mailing Address - Phone:602-795-8700
Mailing Address - Fax:602-795-8701
Practice Address - Street 1:7200 W BELL RD
Practice Address - Street 2:STE F101
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-8529
Practice Address - Country:US
Practice Address - Phone:602-795-8700
Practice Address - Fax:602-795-8701
Is Sole Proprietor?:No
Enumeration Date:2007-08-05
Last Update Date:2021-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COCDR.0000846207LP2900X
AZ4766207LP2900X
OH34.008948207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ346778Medicaid
AZ346778Medicaid