Healthcare Provider Details

I. General information

NPI: 1063919041
Provider Name (Legal Business Name): PAUL MICHAEL HOGAN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2018
Last Update Date: 11/08/2024
Certification Date: 11/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 N WILMA AVE STE A
RIPON CA
95366-9503
US

IV. Provider business mailing address

521 N WILMA AVE STE A
RIPON CA
95366-9003
US

V. Phone/Fax

Practice location:
  • Phone: 209-599-4211
  • Fax: 209-599-7348
Mailing address:
  • Phone: 209-599-4211
  • Fax: 209-599-7348

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20A17596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: