Provider Demographics
NPI:1205882248
Name:HOBGOOD, ROGER LEE (DO)
Entity type:Individual
Prefix:DR
First Name:ROGER
Middle Name:LEE
Last Name:HOBGOOD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 S SCOTT ST
Mailing Address - Street 2:
Mailing Address - City:SAPULPA
Mailing Address - State:OK
Mailing Address - Zip Code:74066-6240
Mailing Address - Country:US
Mailing Address - Phone:918-815-7767
Mailing Address - Fax:877-407-2623
Practice Address - Street 1:1932 S SCOTT ST
Practice Address - Street 2:
Practice Address - City:SAPULPA
Practice Address - State:OK
Practice Address - Zip Code:74066-6240
Practice Address - Country:US
Practice Address - Phone:918-815-7767
Practice Address - Fax:877-407-2623
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-25
Last Update Date:2017-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS0528649207L00000X
OK2623207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
E69805Medicare UPIN