Provider Demographics
NPI:1588879316
Name:HOGAN, FAWN S (MD)
Entity type:Individual
Prefix:DR
First Name:FAWN
Middle Name:S
Last Name:HOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:40 GALLERIA DR
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78257-1712
Mailing Address - Country:US
Mailing Address - Phone:210-378-0974
Mailing Address - Fax:
Practice Address - Street 1:3551 ROGER BROOKE DR BLDG 3600
Practice Address - Street 2:
Practice Address - City:FORT SAM HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:78234
Practice Address - Country:US
Practice Address - Phone:210-916-3216
Practice Address - Fax:210-916-3758
Is Sole Proprietor?:No
Enumeration Date:2007-05-14
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA0101236982208600000X, 208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery