Provider Demographics
NPI:1891704086
Name:HOGAN, AMY E (MD)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:E
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:E
Other - Last Name:MARTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 1815
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67402-1815
Mailing Address - Country:US
Mailing Address - Phone:785-404-1603
Mailing Address - Fax:
Practice Address - Street 1:600 S SANTA FE AVE
Practice Address - Street 2:SUITE E
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-4148
Practice Address - Country:US
Practice Address - Phone:785-404-1603
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-31120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS200311080DMedicaid
KSKA225800Medicare PIN
KSI30287Medicare UPIN