Provider Demographics
NPI:1225200751
Name:NEAL W MOGK MD PC.
Entity Type:Organization
Organization Name:NEAL W MOGK MD PC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NEAL
Authorized Official - Middle Name:W
Authorized Official - Last Name:MOGK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:928-774-7345
Mailing Address - Street 1:715 N BEAVER ST
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-3141
Mailing Address - Country:US
Mailing Address - Phone:928-774-7345
Mailing Address - Fax:928-774-4622
Practice Address - Street 1:715 N BEAVER ST
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-3141
Practice Address - Country:US
Practice Address - Phone:928-774-7345
Practice Address - Fax:928-774-4622
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-25
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAZ17321207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0848210OtherBCBS
AZ277477Medicaid
AZAZ0848210OtherBCBS
AZC99998Medicare UPIN