Provider Demographics
NPI:1679777189
Name:HOGG, BENJAMIN REAVES (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:REAVES
Last Name:HOGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 NORTH BLVD, STE 1
Mailing Address - Street 2:PO BOX 6284
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71307-6284
Mailing Address - Country:US
Mailing Address - Phone:318-442-8399
Mailing Address - Fax:318-448-9897
Practice Address - Street 1:819 WHITFIELD DR
Practice Address - Street 2:
Practice Address - City:NATCHITOCHES
Practice Address - State:LA
Practice Address - Zip Code:71457-6134
Practice Address - Country:US
Practice Address - Phone:318-214-4546
Practice Address - Fax:318-448-9897
Is Sole Proprietor?:No
Enumeration Date:2007-06-11
Last Update Date:2011-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA0270782085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1679777189OtherNPI
LA1053384Medicaid
TX8J7792Medicare PIN
LA4N894Medicare PIN