Provider Demographics
NPI:1639127012
Name:FOGARTY, STEVEN J (MD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:J
Last Name:FOGARTY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1851 N WEBB RD FL 2
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67206-3413
Mailing Address - Country:US
Mailing Address - Phone:316-858-3831
Mailing Address - Fax:316-691-4472
Practice Address - Street 1:655 N WOODLAWN ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67208-3648
Practice Address - Country:US
Practice Address - Phone:316-684-5158
Practice Address - Fax:316-691-4472
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2013-04-25
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KS0433238207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS1639127012Medicaid
KSP00658154OtherRAILROAD MEDICARE
KSP00658154OtherRAILROAD MEDICARE
KSG80096Medicare UPIN