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General NPI Number Information
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NPI Number | 1073305934
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Entity Type | Individual
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Provider Name | BRADY DEAN HOGGARTH DO
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Gender | Male
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Dates
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Enumeration Date | 05/19/2025
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Last Update Date | 05/19/2025
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Provider Practice Location Address
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Address Line | SANFORD HEALTH 801 N BROADWAY
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City | FARGO
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State | ND
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Zip | 58122-0001
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Country | US
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Telephone | 701-234-6076
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Fax |
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Provider Business Mailing Address
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Address Line | 1522 35TH AVE S
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City | FARGO
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State | ND
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Zip | 58104-6114
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Country | US
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Telephone | 701-368-8826
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 208D00000X
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License Number State | ND
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