Provider Demographics
NPI:1790239705
Name:HOGAN, JOHN
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 N HOLDERRIETH BLVD
Mailing Address - Street 2:1342
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4256
Mailing Address - Country:US
Mailing Address - Phone:832-969-0065
Mailing Address - Fax:
Practice Address - Street 1:122 N HOLDERRIETH BLVD
Practice Address - Street 2:1342
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375-4256
Practice Address - Country:US
Practice Address - Phone:832-969-0065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-08
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZC0007XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Assistant