Individual
MR. LES WAYNE HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OT/L
Contact information
Practice address
707 BOLL WEEVIL CIRCLE, ENTERPRISE, AL 36330
(334) 393-9355
Mailing address
217 TORO RD, HARTFORD, AL 36344-1459
(334) 588-3842
(334) 588-0514
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
1892
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
515-29563
BLUE CROSS BLUE SHIELD
AL
Enumeration date
12/21/2006
Last updated
02/11/2013
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