Healthcare Provider Details

I. General information

NPI: 1952044927
Provider Name (Legal Business Name): JASON HOGGE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2022
Last Update Date: 06/30/2025
Certification Date: 06/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 TIETON DR
YAKIMA WA
98902-3761
US

IV. Provider business mailing address

1555 NORTHWAY DR STE 200
SAINT CLOUD MN
56303-4913
US

V. Phone/Fax

Practice location:
  • Phone: 509-249-5210
  • Fax: 320-240-3165
Mailing address:
  • Phone: 320-420-3157
  • Fax: 320-240-3165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number75437
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD61678884
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: