Healthcare Provider Details

I. General information

NPI: 1821041856
Provider Name (Legal Business Name): THOMAS J HOGARTY, M.D.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/19/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

206 N BROOKS ST
SHERIDAN WY
82801-3801
US

IV. Provider business mailing address

206 N BROOKS ST
SHERIDAN WY
82801-3801
US

V. Phone/Fax

Practice location:
  • Phone: 307-672-8941
  • Fax: 307-672-7461
Mailing address:
  • Phone: 307-672-8941
  • Fax: 307-672-7461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number2751A
License Number StateWY

VIII. Authorized Official

Name: THOMAS JOSEPH HOGARTY
Title or Position: OWNER
Credential: M.D.
Phone: 307-672-8941