Provider Demographics
NPI:1487117313
Name:HOGSTROM, JEREMY (DO)
Entity type:Individual
Prefix:
First Name:JEREMY
Middle Name:
Last Name:HOGSTROM
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 1:1949 GUNBARREL RD STE 206
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-7133
Mailing Address - Country:US
Mailing Address - Phone:423-495-4349
Mailing Address - Fax:423-495-4934
Practice Address - Street 1:3739 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37415-3520
Practice Address - Country:US
Practice Address - Phone:423-875-0999
Practice Address - Fax:423-875-0896
Is Sole Proprietor?:No
Enumeration Date:2019-04-08
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4761207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine