Provider Demographics
NPI:1790947000
Name:HOGUE, GAVIN NEIL (MD)
Entity Type:Individual
Prefix:DR
First Name:GAVIN
Middle Name:NEIL
Last Name:HOGUE
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 1:102 PATRICK ST
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25312
Mailing Address - Country:US
Mailing Address - Phone:304-346-8213
Mailing Address - Fax:304-346-8214
Practice Address - Street 1:102 PATRICK ST
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25312
Practice Address - Country:US
Practice Address - Phone:304-346-8213
Practice Address - Fax:304-346-8214
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV150292083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine