MEDICARE: ANEITRA HOGGARD M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician	19349	NV

General Provider Information

NPI Number	:	1407235443
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANEITRA HOGGARD M.D.

Provider Business Mailing Address
First Line	:	9127 W RUSSELL RD
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-1240
Country	:	US
Telephone Number	:	702-878-0070
Fax Number	:	702-209-2064

Provider Business Practice Location Address
First Line	:	3186 S MARYLAND PKWY
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-2306
Country	:	US
Telephone Number	:	702-961-8430
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/22/2015
Last Update Date	:	01/29/2020

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