Provider Demographics
NPI:1447415658
Name:WILLIAM J. GOGAN, MD PA
Entity Type:Organization
Organization Name:WILLIAM J. GOGAN, MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:GOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-848-7768
Mailing Address - Street 1:701 NORTHLAKE BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:N PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5215
Mailing Address - Country:US
Mailing Address - Phone:561-848-7768
Mailing Address - Fax:
Practice Address - Street 1:701 NORTHLAKE BLVD
Practice Address - Street 2:SUITE 208
Practice Address - City:N PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5215
Practice Address - Country:US
Practice Address - Phone:561-848-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-28
Last Update Date:2013-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058162207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD49631Medicare UPIN
FLGJ145AMedicare Oscar/Certification