Provider Demographics
NPI:1669430070
Name:VOGT, DOUGLAS EUGENE (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:EUGENE
Last Name:VOGT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 N KEENE ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65201-8102
Mailing Address - Country:US
Mailing Address - Phone:573-442-0320
Mailing Address - Fax:573-442-0421
Practice Address - Street 1:204 N KEENE ST
Practice Address - Street 2:SUITE 100
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-8102
Practice Address - Country:US
Practice Address - Phone:573-442-0320
Practice Address - Fax:573-442-0421
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2014-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOMD108225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO209803808Medicaid
MO209803808Medicaid
MOG73719Medicare UPIN