Healthcare Provider Details

I. General information

NPI: 1023209228
Provider Name (Legal Business Name): PATRICK WILLIAM HOGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 05/10/2021
Certification Date: 05/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 W BELL RD STE F101
GLENDALE AZ
85308-8529
US

IV. Provider business mailing address

20280 N 59TH AVE STE 115-617
GLENDALE AZ
85308-6850
US

V. Phone/Fax

Practice location:
  • Phone: 602-795-8700
  • Fax: 602-795-8701
Mailing address:
  • Phone: 602-795-8700
  • Fax: 602-795-8701

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberCDR.0000846
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number4766
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: