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General NPI Number Information
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NPI Number | 1700027695
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Entity Type | Organization
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Legal Business Name | GRADY C. HOGUE, JR., M.D., P.A.
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Dates
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Enumeration Date | 03/23/2009
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Last Update Date | 03/23/2009
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Provider Practice Location Address
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Address Line | 302 S HILLSIDE DR
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City | BEEVILLE
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State | TX
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Zip | 78102-5333
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Country | US
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Telephone | 361-358-9912
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Fax | 361-358-7640
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Provider Business Mailing Address
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Address Line | 302 S HILLSIDE DR
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City | BEEVILLE
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State | TX
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Zip | 78102-5333
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Country | US
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Telephone | 361-358-9912
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Fax | 361-358-7640
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Authorized Official
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Title or Position | OWNER
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Name | DR. GRADY C HOGUE JR.
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Credential | M.D., P.A.
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Telephone | 361-358-9912
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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 | G8181
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License Number State | TX
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