Provider Demographics
NPI:1942286018
Name:BOGAN, STEPHEN J (MD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:J
Last Name:BOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:1170 WYKE RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4259
Mailing Address - Country:US
Mailing Address - Phone:704-482-6767
Mailing Address - Fax:704-600-6232
Practice Address - Street 1:1170 WYKE RD.
Practice Address - Street 2:
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-3406
Practice Address - Country:US
Practice Address - Phone:704-482-6767
Practice Address - Fax:704-484-2507
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2023-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
SC16420207W00000X
NC36496207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC16428OtherBCBS
16428OtherBLUE CROSS BLUE SHIELD
NC8916428Medicaid
D448817495OtherMC SOUTH CAROLINA
SCN36496Medicaid
0860143OtherUNITED HEALTH CARE
NC16428OtherBCBS
561705541OtherCMS 1500
NC561705541OtherWORKMANS COMP
D44881OtherFIRST HEALTH
561705441OtherAETNA
S341421OtherHEALTHSOURCE SC INC
104386OtherWELLNESS PLAN
2109355OtherMAMSI INSURANCE
SC561705541OtherWORKMANS COMP
0860143OtherUNITED HEALTH CARE
16428OtherBLUE CROSS BLUE SHIELD
2184739Medicare ID - Type Unspecified
NC8916428Medicaid