Provider Demographics
NPI:1962495655
Name:HOGG, JEANNINE ELIZABETH (MD)
Entity Type:Individual
Prefix:
First Name:JEANNINE
Middle Name:ELIZABETH
Last Name:HOGG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 TIMBER VIEW CV
Mailing Address - Street 2:
Mailing Address - City:CORDOVA
Mailing Address - State:TN
Mailing Address - Zip Code:38018-7406
Mailing Address - Country:US
Mailing Address - Phone:773-519-4839
Mailing Address - Fax:
Practice Address - Street 1:1665 BONNIE LN
Practice Address - Street 2:101
Practice Address - City:CORDOVA
Practice Address - State:TN
Practice Address - Zip Code:38016-0548
Practice Address - Country:US
Practice Address - Phone:901-531-8555
Practice Address - Fax:901-531-8560
Is Sole Proprietor?:No
Enumeration Date:2005-08-26
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS26144208000000X
TNMD48269208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
H76063Medicare UPIN
H76063Medicare UPIN