Provider Demographics
NPI:1972775070
Name:WILLIAM M HOGAN, MD, PC
Entity type:Organization
Organization Name:WILLIAM M HOGAN, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:865-993-8787
Mailing Address - Street 1:PO BOX 31649
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37930-1649
Mailing Address - Country:US
Mailing Address - Phone:865-593-4000
Mailing Address - Fax:
Practice Address - Street 1:1432 HICKEY RD
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37932-2017
Practice Address - Country:US
Practice Address - Phone:865-593-4000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-28
Last Update Date:2018-01-25
Deactivation Date:2017-05-01
Deactivation Code:
Reactivation Date:2018-01-25
Provider Licenses
StateLicense IDTaxonomies
TNMD 142212084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN021709OtherBLUECROSS BLUESHIELD
TN3197893Medicaid
TN021709OtherBLUECROSS BLUESHIELD
TN3197893Medicare PIN