Healthcare Provider Details

I. General information

NPI: 1780641480
Provider Name (Legal Business Name): JOHN MARTIN HOGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 09/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E DUARTE RD
DUARTE CA
91010
US

IV. Provider business mailing address

1333 S MAYFLOWER AVE 2ND FLOOR
MONROVIA CA
91016-5266
US

V. Phone/Fax

Practice location:
  • Phone: 626-359-8111
  • Fax:
Mailing address:
  • Phone: 626-775-3514
  • Fax: 626-408-3911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA26332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: