Provider Demographics
NPI:1821041856
Name:THOMAS J HOGARTY, M.D.
Entity Type:Organization
Organization Name:THOMAS J HOGARTY, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:HOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:307-672-8941
Mailing Address - Street 1:206 N BROOKS ST
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-3801
Mailing Address - Country:US
Mailing Address - Phone:307-672-8941
Mailing Address - Fax:307-672-7461
Practice Address - Street 1:206 N BROOKS ST
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-3801
Practice Address - Country:US
Practice Address - Phone:307-672-8941
Practice Address - Fax:307-672-7461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2751A207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0074659Medicaid
A72958Medicare UPIN
MT0074659Medicaid