Healthcare Provider Details

I. General information

NPI: 1366613440
Provider Name (Legal Business Name): CODY NATHANIEL HOGESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2008
Last Update Date: 06/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1120 WELLINGTON AVE
GRAND JUNCTION CO
81501-6129
US

IV. Provider business mailing address

1120 WELLINGTON AVE STE 206
GRAND JUNCTION CO
81501-6131
US

V. Phone/Fax

Practice location:
  • Phone: 970-243-7245
  • Fax:
Mailing address:
  • Phone: 970-243-7245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR.0047887
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number01062119A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: