Healthcare Provider Details

I. General information

NPI: 1497842868
Provider Name (Legal Business Name): DONALD GREGORY VOGT DPM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2006
Last Update Date: 08/12/2022
Certification Date: 08/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1760 CHICAGO AVE STE 3
RIVERSIDE CA
92507-2300
US

IV. Provider business mailing address

1621 KINGSPORT DR
RIVERSIDE CA
92506-5451
US

V. Phone/Fax

Practice location:
  • Phone: 951-781-2200
  • Fax:
Mailing address:
  • Phone: 951-756-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberE2274
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: