Provider Demographics
NPI:1497842868
Name:VOGT, DONALD GREGORY (DPM)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:GREGORY
Last Name:VOGT
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1621 KINGSPORT DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-5451
Mailing Address - Country:US
Mailing Address - Phone:951-756-0454
Mailing Address - Fax:
Practice Address - Street 1:1760 CHICAGO AVE STE 3
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-2300
Practice Address - Country:US
Practice Address - Phone:951-781-2200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE2274213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T11253Medicare UPIN
CA000E22743Medicare PIN
000E22740Medicare PIN
CA5498400001Medicare NSC