Provider Demographics
NPI:1235187279
Name:HOGAN, CHAD A (MD)
Entity Type:Individual
Prefix:
First Name:CHAD
Middle Name:A
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 1:1280 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-7509
Mailing Address - Country:US
Mailing Address - Phone:817-310-0898
Mailing Address - Fax:817-310-5524
Practice Address - Street 1:1280 S MAIN ST STE 100
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-7509
Practice Address - Country:US
Practice Address - Phone:817-310-0898
Practice Address - Fax:817-310-5524
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0268207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX092519003Medicaid
TXG78506Medicare UPIN
TX8J0855Medicare PIN