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NPI Code Detail

MEDICARE: ELIZABETH BROOKS HOGAN D.O.

MEDICARE: ELIZABETH BROOKS HOGAN D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician04705KY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1245761030
Entity Type Code : Individual
Provider Name (Legal Business Name) : ELIZABETH BROOKS HOGAN D.O.
Provider Business Mailing Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 270-659-5885
Fax Number : 270-659-5852
Provider Business Practice Location Address
First Line : 310 N L ROGERS WELLS BLVD
Second Line :
City : GLASGOW
State : KY
Zip : 42141-1300
Country : US
Telephone Number : 502-651-1111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/23/2017
Last Update Date : 12/16/2025

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