Provider Demographics
NPI:1780046524
Name:ZOGAL, STEPHEN
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:ZOGAL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:503 PARK ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGDALE
Mailing Address - State:AR
Mailing Address - Zip Code:72764-5526
Mailing Address - Country:US
Mailing Address - Phone:479-430-8480
Mailing Address - Fax:
Practice Address - Street 1:503 PARK ST
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72764-5526
Practice Address - Country:US
Practice Address - Phone:479-430-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR16-00009274251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health