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NPI Code Detail

MEDICARE: DR. ROBERT JOSEPH GOGAN MD

MEDICARE: DR. ROBERT JOSEPH GOGAN MD
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
1207Y00000XOtolaryngology Physician22771-020WI
2207YS0123XFacial Plastic Surgery Physician222771WI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1040004274OTHERWIRRB
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366434086
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ROBERT JOSEPH GOGAN MD
Provider Business Mailing Address
First Line : 10945 N PORT WASHINGTON RD
Second Line : SUITE 211
City : MEQUON
State : WI
Zip : 53092-5078
Country : US
Telephone Number : 262-241-8000
Fax Number : 262-241-8096
Provider Business Practice Location Address
First Line : 10945 N PORT WASHINGTON RD
Second Line : SUITE 211
City : MEQUON
State : WI
Zip : 53092-5078
Country : US
Telephone Number : 262-241-8000
Fax Number : 262-241-8096
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 10/30/2009

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