Provider Demographics
NPI:1093826067
Name:HOGAN, SCOTT MATTHEW (MD)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:MATTHEW
Last Name:HOGAN
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:P.O. BOX 251708
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72225-1708
Mailing Address - Country:US
Mailing Address - Phone:501-614-7700
Mailing Address - Fax:501-614-7708
Practice Address - Street 1:1601 MURPHY DR
Practice Address - Street 2:
Practice Address - City:MAUMELLE
Practice Address - State:AR
Practice Address - Zip Code:72113-6187
Practice Address - Country:US
Practice Address - Phone:501-803-3388
Practice Address - Fax:501-325-1387
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE09732084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR135107001Medicaid
AR135107001Medicaid