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NPI Code Detail

MEDICARE: DR. BRANDON COY BOGLE PHD

MEDICARE: DR. BRANDON COY BOGLE PHD
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
1103TC0700XClinical Psychologist0810004813VA
2103TC0700XClinical Psychologist3789TN

General Provider Information

NPI Number : 1699082479
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRANDON COY BOGLE PHD
Provider Business Mailing Address
First Line : 4800 N SCOTTSDALE RD STE 2500
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85251-7630
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 5TH ST STE 310
Second Line :
City : BRISTOL
State : TN
Zip : 37620-5919
Country : US
Telephone Number : 865-588-3173
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/01/2010
Last Update Date : 05/22/2026

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