Provider Demographics
NPI:1063684611
Name:KRISTINA BOGAR, DO PA
Entity Type:Organization
Organization Name:KRISTINA BOGAR, DO PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KRISTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:BOGAR
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:713-461-4101
Mailing Address - Street 1:5151 KATY FWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-2260
Mailing Address - Country:US
Mailing Address - Phone:713-461-4101
Mailing Address - Fax:713-864-5355
Practice Address - Street 1:5151 KATY FWY
Practice Address - Street 2:SUITE 100
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-2260
Practice Address - Country:US
Practice Address - Phone:713-461-4101
Practice Address - Fax:713-864-5355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0042MTOtherBCBS
TX0042MTOtherBCBS
TX00920ZMedicare PIN