Provider Demographics
NPI:1376713784
Name:EDWARD F. JOGANIC, M.D., P.C.
Entity Type:Organization
Organization Name:EDWARD F. JOGANIC, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:F
Authorized Official - Last Name:JOGANIC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-266-9066
Mailing Address - Street 1:500 W THOMAS RD
Mailing Address - Street 2:SUITE 960
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85013-4224
Mailing Address - Country:US
Mailing Address - Phone:602-266-9066
Mailing Address - Fax:602-266-5711
Practice Address - Street 1:500 W THOMAS RD
Practice Address - Street 2:SUITE 960
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85013-4224
Practice Address - Country:US
Practice Address - Phone:602-266-9066
Practice Address - Fax:602-266-5711
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2017-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ187782086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ680553Medicaid
AZ296667Medicaid
AZ296667Medicaid
AZE76926Medicare UPIN