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General NPI Number Information
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NPI Number | 1366434086
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Entity Type | Individual
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Provider Name | ROBERT JOSEPH GOGAN MD
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Gender | Male
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 10/30/2009
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Provider Practice Location Address
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Address Line | 10945 N PORT WASHINGTON RD SUITE 211
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City | MEQUON
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State | WI
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Zip | 53092-5078
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Country | US
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Telephone | 262-241-8000
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Fax | 262-241-8096
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Provider Business Mailing Address
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Address Line | 10945 N PORT WASHINGTON RD SUITE 211
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City | MEQUON
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State | WI
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Zip | 53092-5078
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Country | US
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Telephone | 262-241-8000
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Fax | 262-241-8096
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 22771-020
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License Number State | WI
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Taxonomy #2
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Taxonomy Code | 207YS0123X
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Taxonomy Name | Facial Plastic Surgery Physician
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License Number | 222771
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License Number State | WI
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