Provider Demographics
NPI:1891222634
Name:WILLIAM M. HOGAN, MD, PLLC
Entity Type:Organization
Organization Name:WILLIAM M. HOGAN, MD, PLLC
Other - Org Name:WILLIAM M. HOGAN, MD, PC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:865-539-4000
Mailing Address - Street 1:P.O. BOX 31649
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930
Mailing Address - Country:US
Mailing Address - Phone:865-539-4000
Mailing Address - Fax:865-539-8215
Practice Address - Street 1:1432 HICKEY ROAD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932
Practice Address - Country:US
Practice Address - Phone:865-539-4000
Practice Address - Fax:865-539-8215
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD142212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNB04769Medicare UPIN