Provider Demographics
NPI:1669470605
Name:MORT, PATRICIA HOGAN (DO)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:HOGAN
Last Name:MORT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:EILEEN
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1662 S ORCHARD CREST AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-1066
Mailing Address - Country:US
Mailing Address - Phone:417-350-1895
Mailing Address - Fax:
Practice Address - Street 1:5571 N GRETNA RD
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616
Practice Address - Country:US
Practice Address - Phone:417-243-2300
Practice Address - Fax:417-243-2381
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO363782084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200256010DMedicaid
MO241791276Medicaid
MON221549Medicare PIN
KS106365Medicare PIN
MOD16946Medicare UPIN