Provider Demographics
NPI:1447210208
Name:HOGAN, MATTHEW M (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:M
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 1:919 GRAHAM DR
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-6408
Mailing Address - Country:US
Mailing Address - Phone:281-516-6530
Mailing Address - Fax:281-290-9824
Practice Address - Street 1:919 GRAHAM DR
Practice Address - Street 2:
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-6408
Practice Address - Country:US
Practice Address - Phone:281-516-6530
Practice Address - Fax:281-290-9824
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL6064208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX158925101Medicaid
TXP00099173Medicare PIN
8A8641Medicare ID - Type Unspecified
H88136Medicare UPIN