Provider Demographics
NPI:1366203572
Name:HOGAN, CAROL MARIE
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:MARIE
Last Name:HOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 NW 25TH ST # 5
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5619
Mailing Address - Country:US
Mailing Address - Phone:405-982-5293
Mailing Address - Fax:
Practice Address - Street 1:901 NW 25TH ST # 5
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5619
Practice Address - Country:US
Practice Address - Phone:405-982-5293
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-16
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist