Provider Demographics
NPI:1689669970
Name:HOGLE, GREGORY ALLEN (DO)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:ALLEN
Last Name:HOGLE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 HALE PKWY
Mailing Address - Street 2:STE 450
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80220-4020
Mailing Address - Country:US
Mailing Address - Phone:303-333-2119
Mailing Address - Fax:303-333-2016
Practice Address - Street 1:4600 HALE PKWY
Practice Address - Street 2:STE 450
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80220-4020
Practice Address - Country:US
Practice Address - Phone:303-333-2119
Practice Address - Fax:303-333-2016
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-13
Last Update Date:2008-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO27338207Y00000X, 207YX0007X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & Neck
No207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01273382Medicaid
CA01273382Medicaid
CO5162Medicare ID - Type Unspecified