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General NPI Number Information
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NPI Number | 1225200751
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Entity Type | Organization
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Legal Business Name | NEAL W MOGK MD PC.
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Dates
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Enumeration Date | 03/25/2008
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Last Update Date | 01/09/2009
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Provider Practice Location Address
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Address Line | 715 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3141
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Country | US
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Telephone | 928-774-7345
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Fax | 928-774-4622
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Provider Business Mailing Address
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Address Line | 715 N BEAVER ST
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City | FLAGSTAFF
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State | AZ
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Zip | 86001-3141
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Country | US
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Telephone | 928-774-7345
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Fax | 928-774-4622
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Authorized Official
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Title or Position | OWNER/ DOCTOR
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Name | DR. NEAL W MOGK
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Credential |
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Telephone | 928-774-7345
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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 | AZ17321
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License Number State | AZ
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