Provider Demographics
NPI:1053323956
Name:COGAN, JOSEPH D (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOSEPH
Middle Name:D
Last Name:COGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:14716 HARMON SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72704-0334
Mailing Address - Country:US
Mailing Address - Phone:479-443-4301
Mailing Address - Fax:479-587-5951
Practice Address - Street 1:1100 N COLLEGE AVE
Practice Address - Street 2:DEPT 116A
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-1944
Practice Address - Country:US
Practice Address - Phone:479-443-4301
Practice Address - Fax:479-587-5951
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK1379363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant