Provider Demographics
NPI:1235215054
Name:VOGEL, TODD R
Entity Type:Individual
Prefix:
First Name:TODD
Middle Name:R
Last Name:VOGEL
Suffix:
Gender:M
Credentials:
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 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-2259
Mailing Address - Fax:
Practice Address - Street 1:ONE HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-884-1975
Practice Address - Fax:573-884-5049
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2012-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000453252086S0129X
NJ25MA069580002086S0129X
MO20110364142086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8436735Medicaid
NJP00451749OtherRR MCR PTAN
NJ0154458Medicaid
338010OtherINTERNAL ID-MOTOR VEHICLE ID
NJP00451749OtherRR MCR PTAN
NJ116217NAHMedicare PIN
MO152360555Medicare PIN
I38943Medicare UPIN