Provider Demographics
NPI:1043437767
Name:VOGT, TERRY L (PA)
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:L
Last Name:VOGT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:444 FOUR STATES DR
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4324
Mailing Address - Country:US
Mailing Address - Phone:620-783-4441
Mailing Address - Fax:620-783-4444
Practice Address - Street 1:444 FOUR STATES DR
Practice Address - Street 2:SUITE 1
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739
Practice Address - Country:US
Practice Address - Phone:620-783-4441
Practice Address - Fax:620-783-4444
Is Sole Proprietor?:No
Enumeration Date:2007-04-20
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01156363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSMV1524481OtherDEA