Provider Demographics
NPI:1245237734
Name:HOGAN, PATRICK J III (DO)
Entity type:Individual
Prefix:
First Name:PATRICK
Middle Name:J
Last Name:HOGAN
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5006 CENTER ST STE U
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-2314
Mailing Address - Country:US
Mailing Address - Phone:253-284-4488
Mailing Address - Fax:253-272-4771
Practice Address - Street 1:5006 CENTER ST STE U
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-2314
Practice Address - Country:US
Practice Address - Phone:253-284-4488
Practice Address - Fax:253-272-4771
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-30
Last Update Date:2024-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOP000007932084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H02398OtherREGENCE BS
911370954OtherPREMERA BC
911370954OtherALL COMMERCIAL INSURANCE
13162OtherSTATE L & I
GH047945001OtherGROUP HEALTH
911370954OtherALL COMMERCIAL INSURANCE
D99923Medicare UPIN