Individual
DR. JASON PORTER HOGABOAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
20599 MACK AVE, GROSSE POINTE MEDPOST URGENT CARE, GROSSE POINTE WOODS, MI 48236-1656
(517) 279-5400
Mailing address
761 SANDALWOOD DR, TROY, MI 48085-1643
(509) 264-1814
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101019788
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A26570059
MEDICARE ID
MI
Enumeration date
07/01/2012
Last updated
01/24/2017
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