Provider Demographics
NPI:1437655701
Name:HOGAN, GLEN R
Entity Type:Individual
Prefix:
First Name:GLEN
Middle Name:R
Last Name:HOGAN
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 1:13110 KUYKENDAHL RD APT 703
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-6708
Mailing Address - Country:US
Mailing Address - Phone:281-914-1057
Mailing Address - Fax:
Practice Address - Street 1:13110 KUYKENDAHL RD APT 703
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-6708
Practice Address - Country:US
Practice Address - Phone:281-914-1057
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-04
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility