Provider Demographics
NPI:1063408896
Name:VOGEL, ROBERT A (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:VOGEL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 S 3270 W
Mailing Address - Street 2:
Mailing Address - City:WEST VALLEY CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84119-1119
Mailing Address - Country:US
Mailing Address - Phone:385-261-2737
Mailing Address - Fax:801-746-0420
Practice Address - Street 1:610 S 200 E STE B
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84111-3802
Practice Address - Country:US
Practice Address - Phone:801-539-8617
Practice Address - Fax:801-746-0420
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2023-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7270207R00000X
UT11907436-1205207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX120533802Medicaid
TX889336OtherFIRST HEALTH
TX120533802Medicaid
TX126211100OtherFIRST CARE
TX8AW608OtherBCBS
TX8AW608OtherBCBS
TXC23009Medicare UPIN