=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699775387
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JUDITH E. HOGG M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/26/2005
-----------------------------------------------------
Last Update Date | 04/10/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 S COULTER ST B-217
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-350-3000
-----------------------------------------------------
Fax | 806-350-3003
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1600 S COULTER ST B-217
-----------------------------------------------------
City | AMARILLO
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79106-1710
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 806-350-3000
-----------------------------------------------------
Fax | 806-350-3003
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2084N0400X
-----------------------------------------------------
Taxonomy Name | Neurology Physician
-----------------------------------------------------
License Number | J0528
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------