Provider Demographics
NPI:1013985985
Name:BOGNER, PAUL F (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:F
Last Name:BOGNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 MEDICAL CENTER DR
Mailing Address - Street 2:STE 101
Mailing Address - City:NEWTON
Mailing Address - State:KS
Mailing Address - Zip Code:67114-9017
Mailing Address - Country:US
Mailing Address - Phone:316-283-2800
Mailing Address - Fax:316-283-3575
Practice Address - Street 1:700 MEDICAL CENTER DR
Practice Address - Street 2:STE 101
Practice Address - City:NEWTON
Practice Address - State:KS
Practice Address - Zip Code:67114-9017
Practice Address - Country:US
Practice Address - Phone:316-283-2800
Practice Address - Fax:316-283-3575
Is Sole Proprietor?:No
Enumeration Date:2006-03-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS0418813208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS111178029OtherPTAN
KS100205180FMedicaid
AB9336199OtherDEA
KS100205180FMedicaid
KS111178029OtherPTAN