Healthcare Provider Details

I. General information

NPI: 1871811141
Provider Name (Legal Business Name): KRISTI AMANDA BOGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTI OATIS MD

II. Dates (important events)

Enumeration Date: 05/12/2010
Last Update Date: 10/11/2022
Certification Date: 10/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 6TH AVE S
ST PETERSBURG FL
33701-4634
US

IV. Provider business mailing address

1100 SOUTH BLVD APT 322
CHARLOTTE NC
28203-7001
US

V. Phone/Fax

Practice location:
  • Phone: 727-767-4243
  • Fax:
Mailing address:
  • Phone: 469-617-1106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberME141682
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code2085P0229X
TaxonomyPediatric Radiology Physician
License NumberTP107
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberTP107
License Number StateKY
# 4
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: