Provider Demographics
NPI:1891726444
Name:BOGART, ALVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:ALVIN
Middle Name:
Last Name:BOGART
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:PO BOX 9907
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85068
Mailing Address - Country:US
Mailing Address - Phone:602-485-7421
Mailing Address - Fax:602-485-7440
Practice Address - Street 1:18404 N TATUM BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-1510
Practice Address - Country:US
Practice Address - Phone:602-485-7421
Practice Address - Fax:602-485-7440
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ09262207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZC99172Medicare UPIN
AZ106697Medicare ID - Type Unspecified