Healthcare Provider Details

I. General information

NPI: 1205095346
Provider Name (Legal Business Name): ADAM PATRICK VOGT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/04/2008
Last Update Date: 05/06/2021
Certification Date: 05/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1725 PINE ST. JACKSON HOSPITAL DEPARTMENT OF PATHOLOGY
MONTGOMERY AL
36106
US

IV. Provider business mailing address

5008 MOXON ST
MONTGOMERY AL
36116-6777
US

V. Phone/Fax

Practice location:
  • Phone: 334-293-8000
  • Fax:
Mailing address:
  • Phone: 719-648-5438
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License NumberME125027
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberME125027
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberME125027
License Number StateFL
# 4
Primary TaxonomyN
Taxonomy Code207ZD0900X
TaxonomyDermatopathology (Pathology) Physician
License NumberMD.36102
License Number StateAL
# 5
Primary TaxonomyY
Taxonomy Code207ZP0101X
TaxonomyAnatomic Pathology Physician
License NumberMD36102
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: