Healthcare Provider Details

I. General information

NPI: 1669769451
Provider Name (Legal Business Name): ERIC S HOGAN D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 03/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1477 N 2000 W SUITE C
CLINTON UT
84015-8638
US

IV. Provider business mailing address

1477 N 2000 W SUITE C
CLINTON UT
84015-8638
US

V. Phone/Fax

Practice location:
  • Phone: 801-774-8888
  • Fax: 801-825-8519
Mailing address:
  • Phone: 801-774-8888
  • Fax: 801-825-8519

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9410724-8904
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: