Provider Demographics
NPI:1518224708
Name:HOGANCAMP, DAVID RYAN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:RYAN
Last Name:HOGANCAMP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-589-6788
Mailing Address - Fax:502-589-5093
Practice Address - Street 1:2605 KENTUCKY AVE STE 304
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3802
Practice Address - Country:US
Practice Address - Phone:270-415-7050
Practice Address - Fax:270-415-7051
Is Sole Proprietor?:No
Enumeration Date:2012-04-12
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY47895207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100259890Medicaid
IN201296410Medicaid
IN201296410Medicaid