Provider Demographics
NPI:1972780856
Name:HOGAN, JAMIE M (PA)
Entity type:Individual
Prefix:
First Name:JAMIE
Middle Name:M
Last Name:HOGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:M
Other - Last Name:FOSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:605 S CONROE MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:CONROE
Mailing Address - State:TX
Mailing Address - Zip Code:77304-4722
Mailing Address - Country:US
Mailing Address - Phone:936-539-4004
Mailing Address - Fax:936-539-3635
Practice Address - Street 1:605 S CONROE MEDICAL DR
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-4722
Practice Address - Country:US
Practice Address - Phone:936-539-4004
Practice Address - Fax:936-539-3635
Is Sole Proprietor?:No
Enumeration Date:2008-01-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05582363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3281495-04Medicaid
TXMF1759731OtherDEA
TX306139YKP5Medicare PIN
TX328149501Medicaid