Provider Demographics
NPI:1104243120
Name:HOGAN, JUSTIN (MD)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JUSTIN
Other - Middle Name:
Other - Last Name:HOGAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:7030 FM 1488 RD STE 220
Mailing Address - Street 2:
Mailing Address - City:MAGNOLIA
Mailing Address - State:TX
Mailing Address - Zip Code:77354-6772
Mailing Address - Country:US
Mailing Address - Phone:346-703-2072
Mailing Address - Fax:
Practice Address - Street 1:7030 FM 1488 RD STE 220
Practice Address - Street 2:
Practice Address - City:MAGNOLIA
Practice Address - State:TX
Practice Address - Zip Code:77354-6772
Practice Address - Country:US
Practice Address - Phone:346-703-2075
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2023-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA390200000X
TXR3344207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program