Healthcare Provider Details

I. General information

NPI: 1003213166
Provider Name (Legal Business Name): AUSTIN G HOGLAND PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2014
Last Update Date: 06/07/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 SW 39TH ST SUITE 150
RENTON WA
98057-4912
US

IV. Provider business mailing address

PO BOX 59028
RENTON WA
98058-2028
US

V. Phone/Fax

Practice location:
  • Phone: 425-793-4700
  • Fax: 425-251-4302
Mailing address:
  • Phone: 425-251-5110
  • Fax: 425-793-4707

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60518925
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA60518925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: