Provider Demographics
NPI:1942280797
Name:GOGEL, PHILIP F (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:F
Last Name:GOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 CHIPPEWA ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63109-2356
Mailing Address - Country:US
Mailing Address - Phone:314-481-5000
Mailing Address - Fax:314-481-3037
Practice Address - Street 1:505 BUCKEYE DR
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:IL
Practice Address - Zip Code:62294-2315
Practice Address - Country:US
Practice Address - Phone:314-481-5000
Practice Address - Fax:314-481-3037
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036114471208D00000X
MO2005037958202K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No202K00000XAllopathic & Osteopathic PhysiciansPhlebology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431941391OtherTAX ID
MO505738906Medicaid
IL03611471Medicaid
MO431941391OtherTAX ID
IL03611471Medicaid