Provider Demographics
NPI:1952639288
Name:HOGAN, SARAH E (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:SARAH
Middle Name:E
Last Name:HOGAN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:200 BREVCO PLZ
Mailing Address - Street 2:SUITE 208
Mailing Address - City:LAKE ST LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-2949
Mailing Address - Country:US
Mailing Address - Phone:636-561-9020
Mailing Address - Fax:636-561-6208
Practice Address - Street 1:621 S NEW BALLAS RD
Practice Address - Street 2:SUITE 598
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8232
Practice Address - Country:US
Practice Address - Phone:314-251-3380
Practice Address - Fax:314-251-3385
Is Sole Proprietor?:No
Enumeration Date:2009-11-24
Last Update Date:2015-11-02
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Provider Licenses
StateLicense IDTaxonomies
MO2009035756363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1952639288Medicare PIN