Provider Demographics
NPI:1396854824
Name:VOGEL, DAVID PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:PAUL
Last Name:VOGEL
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 1:5606 SW LEE BLVD
Mailing Address - Street 2:SUITE 306
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-9688
Mailing Address - Country:US
Mailing Address - Phone:712-255-8827
Mailing Address - Fax:712-255-4862
Practice Address - Street 1:5606 SW LEE BLVD
Practice Address - Street 2:SUITE 306
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73505-9688
Practice Address - Country:US
Practice Address - Phone:712-255-8827
Practice Address - Fax:712-255-4862
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD054201L174400000X
IA38349207R00000X, 207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1396854824Medicaid
VA005876532Medicaid
VA005876532Medicaid
VA110008501Medicare ID - Type Unspecified