Provider Demographics
NPI:1033288329
Name:VOGEL, BRUCE GREGORY (DO)
Entity Type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:GREGORY
Last Name:VOGEL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 CAMPBELL LANE
Mailing Address - Street 2:
Mailing Address - City:YERINGTON
Mailing Address - State:NV
Mailing Address - Zip Code:89447
Mailing Address - Country:US
Mailing Address - Phone:775-463-3335
Mailing Address - Fax:775-463-0165
Practice Address - Street 1:171 CAMPBELL LANE
Practice Address - Street 2:
Practice Address - City:YERINGTON
Practice Address - State:NV
Practice Address - Zip Code:89447
Practice Address - Country:US
Practice Address - Phone:775-463-3335
Practice Address - Fax:775-463-0165
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV637208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
C00887Medicare UPIN
35934Medicare ID - Type Unspecified