Provider Demographics
NPI:1568662914
Name:MARK D. BOGAR, MD, PA
Entity Type:Organization
Organization Name:MARK D. BOGAR, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE MANAGEMENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MORGAN
Authorized Official - Middle Name:B
Authorized Official - Last Name:KRULL
Authorized Official - Suffix:
Authorized Official - Credentials:MSHP-HA
Authorized Official - Phone:512-363-5779
Mailing Address - Street 1:4321 BROWNFIELD RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79407-2504
Mailing Address - Country:US
Mailing Address - Phone:512-363-5779
Mailing Address - Fax:512-292-4458
Practice Address - Street 1:4321 BROWNFIELD RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79407-2504
Practice Address - Country:US
Practice Address - Phone:512-363-5779
Practice Address - Fax:512-292-4458
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL3246208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty