Healthcare Provider Details

I. General information

NPI: 1790761682
Provider Name (Legal Business Name): THOMAS JOSEPH HOGARTY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/21/2005
Last Update Date: 02/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3111 GUNDERSEN DR
ONALASKA WI
54650-8447
US

IV. Provider business mailing address

PO BOX 155
BIG HORN WY
82833-0155
US

V. Phone/Fax

Practice location:
  • Phone: 307-752-7546
  • Fax:
Mailing address:
  • Phone: 307-752-7546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2751A
License Number StateWY
# 2
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberD0067132
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number19597-20
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: