Provider Demographics
NPI:1497715775
Name:HOGANSON, NEAL EDWARD (MD)
Entity Type:Individual
Prefix:DR
First Name:NEAL
Middle Name:EDWARD
Last Name:HOGANSON
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:PO BOX 844658
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-4658
Mailing Address - Country:US
Mailing Address - Phone:254-724-2111
Mailing Address - Fax:
Practice Address - Street 1:1110 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77840-2626
Practice Address - Country:US
Practice Address - Phone:979-691-3295
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2022-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ90962086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX81X057OtherBLUE SHIELD
TX1024762-02Medicaid
TX81X057OtherBLUE SHIELD
TX1024762-01OtherCSHCN
TX1024762-01OtherCSHCN
TX81X057OtherBLUE SHIELD