Provider Demographics
NPI:1083672836
Name:GOGEL, BRIAN MATTHEW (MD)
Entity Type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:MATTHEW
Last Name:GOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 911230
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75391-1230
Mailing Address - Country:US
Mailing Address - Phone:972-997-8000
Mailing Address - Fax:972-234-2987
Practice Address - Street 1:7777 FOREST LN
Practice Address - Street 2:C-585
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75230-2571
Practice Address - Country:US
Practice Address - Phone:972-566-4880
Practice Address - Fax:972-566-6256
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2013-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK2156208600000X, 2086X0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX030086504Medicaid
TX030086502Medicaid
TXP01170816OtherRAILROAD MEDICARE
TX030086503Medicaid
TXH11327Medicare UPIN
TX8693B1Medicare ID - Type Unspecified
TX030086504Medicaid
TXP01170816OtherRAILROAD MEDICARE