Provider Demographics
NPI:1982691531
Name:HOGAN, MICHAEL BRIAN (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2550 FLOWOOD DR STE 402
Mailing Address - Street 2:
Mailing Address - City:FLOWOOD
Mailing Address - State:MS
Mailing Address - Zip Code:39232-9307
Mailing Address - Country:US
Mailing Address - Phone:228-388-1805
Mailing Address - Fax:601-936-1395
Practice Address - Street 1:147 REYNOIR ST STE 205
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4121
Practice Address - Country:US
Practice Address - Phone:228-436-1225
Practice Address - Fax:228-436-1691
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2018-10-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN01056020A208600000X
MS218972086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08885816Medicaid