Provider Demographics
NPI:1962654582
Name:HOGAN, CASSIDY (PA-C)
Entity Type:Individual
Prefix:
First Name:CASSIDY
Middle Name:
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CASSIDY
Other - Middle Name:
Other - Last Name:SEIDL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1601 E 19TH AVE
Mailing Address - Street 2:SUITE 6300
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80218-1216
Mailing Address - Country:US
Mailing Address - Phone:303-869-2182
Mailing Address - Fax:303-869-1906
Practice Address - Street 1:1601 E 19TH AVE
Practice Address - Street 2:SUITE 6300
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80218-1216
Practice Address - Country:US
Practice Address - Phone:303-869-2182
Practice Address - Fax:303-869-1906
Is Sole Proprietor?:No
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2138363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO1068333OtherNCCPA