Provider Demographics
NPI:1255529806
Name:HOGAN, M'LISS ERIN (MD)
Entity type:Individual
Prefix:DR
First Name:M'LISS
Middle Name:ERIN
Last Name:HOGAN
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 1:4212 BLUEBONNET BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-399-0001
Mailing Address - Fax:225-399-0008
Practice Address - Street 1:1431 OCHSNER BLVD
Practice Address - Street 2:STE B
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433
Practice Address - Country:US
Practice Address - Phone:985-590-3488
Practice Address - Fax:985-590-3499
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-09
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.203311208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1005771Medicaid