Provider Demographics
NPI:1255635397
Name:HOGAN, ALLISON MARY (PA)
Entity type:Individual
Prefix:
First Name:ALLISON
Middle Name:MARY
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6850 TPC DR STE 116
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-3145
Mailing Address - Country:US
Mailing Address - Phone:972-838-1635
Mailing Address - Fax:729-838-1634
Practice Address - Street 1:6850 TPC DR STE 116
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070
Practice Address - Country:US
Practice Address - Phone:972-838-1635
Practice Address - Fax:729-838-1634
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA07181363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
8JL069OtherBLUECROSS BLUESHIELD
AL156841Medicaid
AL511-44839OtherBCBS OF AL - HEALTHWEST
AL156830Medicaid
GA003144822CMedicaid
AL511-44838OtherBCBS OF AL - RCC
AL1255635397OtherMEDICARE ID