Provider Demographics
NPI:1063919041
Name:HOGAN, PAUL MICHAEL (DO)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:MICHAEL
Last Name:HOGAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:521 N WILMA AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RIPON
Mailing Address - State:CA
Mailing Address - Zip Code:95366-9003
Mailing Address - Country:US
Mailing Address - Phone:209-599-4211
Mailing Address - Fax:209-599-7348
Practice Address - Street 1:521 N WILMA AVE STE A
Practice Address - Street 2:
Practice Address - City:RIPON
Practice Address - State:CA
Practice Address - Zip Code:95366-9503
Practice Address - Country:US
Practice Address - Phone:209-599-4211
Practice Address - Fax:209-599-7348
Is Sole Proprietor?:No
Enumeration Date:2018-04-06
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A17596207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine