Provider Demographics
NPI:1215197280
Name:HOGUE, SHELLEY L (DPM)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:L
Last Name:HOGUE
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:SHELLEY
Other - Middle Name:L
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DPM
Mailing Address - Street 1:PO BOX 3500
Mailing Address - Street 2:DEPT NO 618
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74018-3500
Mailing Address - Country:US
Mailing Address - Phone:918-274-1557
Mailing Address - Fax:918-274-8557
Practice Address - Street 1:800 W BOISE CIR
Practice Address - Street 2:STE. 150
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-4906
Practice Address - Country:US
Practice Address - Phone:918-274-1557
Practice Address - Fax:918-274-8557
Is Sole Proprietor?:No
Enumeration Date:2008-06-13
Last Update Date:2014-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA000812T213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery