Individual
JASON LEE HOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
4530 NORTHERN SKY DR, BISMARCK, ND 58503
(701) 751-6336
(701) 751-6337
Mailing address
4530 NORTHERN SKY DR, BISMARCK, ND 58503-8534
(701) 751-6336
(701) 751-6337
Taxonomy
Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
1327
ND
225100000X
Physical Therapist
7874
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1464160
—
ND
01
—
24625
BLUE CROSS BLUE SHIELD
ND
05
—
861347800
—
MN
Enumeration date
03/14/2007
Last updated
07/03/2019
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