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NPI Code Detail

MEDICARE: JEREMY HOGSTROM DO

MEDICARE: JEREMY HOGSTROM DO
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
1207R00000XInternal Medicine Physician4761TN

General Provider Information

NPI Number : 1487117313
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY HOGSTROM DO
Provider Business Mailing Address
First Line : 1949 GUNBARREL RD STE 206
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37421-7133
Country : US
Telephone Number : 423-495-4349
Fax Number : 423-495-4934
Provider Business Practice Location Address
First Line : 3739 HIXSON PIKE
Second Line :
City : CHATTANOOGA
State : TN
Zip : 37415-3520
Country : US
Telephone Number : 423-875-0999
Fax Number : 423-875-0896
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/08/2019
Last Update Date : 09/09/2022

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