Provider Demographics
NPI:1851324024
Name:HOGEN, DALE A (MD)
Entity Type:Individual
Prefix:
First Name:DALE
Middle Name:A
Last Name:HOGEN
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 1:353 FAIRMONT BLVD
Mailing Address - Street 2:ATTEN MEDICAL STAFF SERVICES
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-6000
Mailing Address - Country:US
Mailing Address - Phone:605-719-7109
Mailing Address - Fax:605-719-1027
Practice Address - Street 1:101 E. 3RD ST
Practice Address - Street 2:
Practice Address - City:NEWELL
Practice Address - State:SD
Practice Address - Zip Code:57760
Practice Address - Country:US
Practice Address - Phone:605-456-2462
Practice Address - Fax:605-456-1001
Is Sole Proprietor?:No
Enumeration Date:2006-07-09
Last Update Date:2011-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDSD1180207Q00000X
SD1180207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E48020Medicare UPIN
SDS40256Medicare PIN
SDS103136Medicare PIN