Provider Demographics
NPI:1366434086
Name:GOGAN, ROBERT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:GOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10945 N PORT WASHINGTON RD
Mailing Address - Street 2:SUITE 211
Mailing Address - City:MEQUON
Mailing Address - State:WI
Mailing Address - Zip Code:53092-5078
Mailing Address - Country:US
Mailing Address - Phone:262-241-8000
Mailing Address - Fax:262-241-8096
Practice Address - Street 1:10945 N PORT WASHINGTON RD
Practice Address - Street 2:SUITE 211
Practice Address - City:MEQUON
Practice Address - State:WI
Practice Address - Zip Code:53092-5078
Practice Address - Country:US
Practice Address - Phone:262-241-8000
Practice Address - Fax:262-241-8096
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI22771-020207Y00000X
WI222771207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI040004274OtherRRB
WI30326800Medicaid
B53115Medicare UPIN
WI30326800Medicaid