Provider Demographics
NPI:1871649285
Name:PATRICK J. HOGAN III, D.O.
Entity Type:Organization
Organization Name:PATRICK J. HOGAN III, D.O.
Other - Org Name:PUGET SOUND NEUROLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:MARICLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-627-3547
Mailing Address - Street 1:2201 S 19TH ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2962
Mailing Address - Country:US
Mailing Address - Phone:253-627-3547
Mailing Address - Fax:253-272-4771
Practice Address - Street 1:2201 S 19TH ST
Practice Address - Street 2:SUITE 200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2962
Practice Address - Country:US
Practice Address - Phone:253-627-3547
Practice Address - Fax:253-272-4771
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA13162OtherLABOR & INDUSTRIES
WA1031178Medicaid
WA1031178Medicaid