Provider Demographics
NPI:1396722492
Name:MOGAB, JOHN C (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:C
Last Name:MOGAB
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:191 UNIVERSITY BLVD
Mailing Address - Street 2:#713
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80206-4613
Mailing Address - Country:US
Mailing Address - Phone:303-377-6825
Mailing Address - Fax:
Practice Address - Street 1:191 UNIVERSITY BLVD
Practice Address - Street 2:#713
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80206-4613
Practice Address - Country:US
Practice Address - Phone:303-377-6825
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO20241207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE84113438513Medicaid
FL907490200Medicaid
WY118748100Medicaid
MT3506685Medicaid
ME431593700Medicaid
CO01202415Medicaid
NM54727758Medicaid
KS100459020AMedicaid
NM54727758Medicaid
WY118748100Medicaid
CO01202415Medicaid