Individual
MELANIE HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
5744 FATHOM DR, FORT WORTH, TX 76135-7011
(817) 770-2663
Mailing address
5744 FATHOM DR, FORT WORTH, TX 76135-7011
(817) 770-2663
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
—
—
Other
Enumeration date
08/24/2018
Last updated
08/24/2018
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