Healthcare Provider Details

I. General information

NPI: 1316387814
Provider Name (Legal Business Name): REBECCA LYNN HOGG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1511 CHRISTY DR
JEFFERSON CITY MO
65101-2854
US

IV. Provider business mailing address

1 HOSPITAL DR # DC046.00
COLUMBIA MO
65212-1000
US

V. Phone/Fax

Practice location:
  • Phone: 573-632-2777
  • Fax: 573-634-7423
Mailing address:
  • Phone: 573-882-3101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2018036863
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number2013021140
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: