Healthcare Provider Details

I. General information

NPI: 1194033522
Provider Name (Legal Business Name): JOHN MARTIN KOGOY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2010
Last Update Date: 08/13/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

805 6TH AVE W STE 100
HENDERSONVILLE NC
28739
US

IV. Provider business mailing address

PO BOX 27877
SALT LAKE CITY UT
84127-0877
US

V. Phone/Fax

Practice location:
  • Phone: 828-693-7230
  • Fax: 828-698-0583
Mailing address:
  • Phone: 919-966-8279
  • Fax: 919-966-8796

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2014-01328
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: