Provider Demographics
NPI:1508962309
Name:HOGAN, LEE S (PA-C)
Entity Type:Individual
Prefix:
First Name:LEE
Middle Name:S
Last Name:HOGAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 N 60 E
Mailing Address - Street 2:
Mailing Address - City:LA VERKIN
Mailing Address - State:UT
Mailing Address - Zip Code:84745-5505
Mailing Address - Country:US
Mailing Address - Phone:143-561-9151
Mailing Address - Fax:
Practice Address - Street 1:1067 E TABERNACLE ST
Practice Address - Street 2:STE 7
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-3163
Practice Address - Country:US
Practice Address - Phone:143-563-4760
Practice Address - Fax:143-567-4009
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDPA-09363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical