Provider Demographics
NPI:1487947453
Name:HOGAN PROSTHETICS & ORTHOTICS, INC.
Entity type:Organization
Organization Name:HOGAN PROSTHETICS & ORTHOTICS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RAYMOND
Authorized Official - Middle Name:DANIEL
Authorized Official - Last Name:SHORES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-287-4323
Mailing Address - Street 1:6001 BROKEN SOUND PARKWAY
Mailing Address - Street 2:SUITE 420
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33487-2766
Mailing Address - Country:US
Mailing Address - Phone:888-287-4323
Mailing Address - Fax:
Practice Address - Street 1:6001 BROKEN SOUND PKWY STE 420
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33487-2766
Practice Address - Country:US
Practice Address - Phone:888-287-4323
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-24
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL332B00000X
FLPOR 108224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetistGroup - Multi-Specialty
Yes332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty