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General NPI Number Information
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NPI Number | 1295141596
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Entity Type | Organization
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Legal Business Name | ROSS HOGAN M.D., LLC
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 110 LAKEVIEW DR SUITE 100
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City | COVINGTON
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State | LA
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Zip | 70433-7511
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Country | US
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Telephone | 985-892-4544
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Fax |
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Provider Business Mailing Address
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Address Line | 110 LAKEVIEW DR SUITE 100
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City | COVINGTON
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State | LA
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Zip | 70433-7511
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Country | US
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Telephone | 985-892-4544
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Fax |
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Authorized Official
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Title or Position | MEMBER
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Name | ROSS HOGAN
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Credential | M.D.
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Telephone | 985-892-4544
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | MD.203704
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License Number State | LA
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