Provider Demographics
NPI:1760429237
Name:ROGER S HOGUE MD PA
Entity Type:Organization
Organization Name:ROGER S HOGUE MD PA
Other - Org Name:HOGUE VEIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:S
Authorized Official - Last Name:HOGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:763-447-2500
Mailing Address - Street 1:7365 KIRKWOOD CT N, STE 120
Mailing Address - Street 2:
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369
Mailing Address - Country:US
Mailing Address - Phone:763-447-2500
Mailing Address - Fax:763-447-2505
Practice Address - Street 1:7365 KIRKWOOD ST N, STE 120
Practice Address - Street 2:
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369
Practice Address - Country:US
Practice Address - Phone:763-447-2500
Practice Address - Fax:763-447-2505
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-01
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN37641202K00000X, 261Q00000X
ND9896261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes202K00000XAllopathic & Osteopathic PhysiciansPhlebologyGroup - Multi-Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND711349Medicare ID - Type UnspecifiedNORIDIAN MEDICARE