Provider Demographics
NPI:1902895600
Name:HOGUE, MICHAEL ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANDREW
Last Name:HOGUE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:920 S BRYANT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73034-5797
Mailing Address - Country:US
Mailing Address - Phone:405-341-4238
Mailing Address - Fax:405-340-0269
Practice Address - Street 1:920 S BRYANT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73034-5797
Practice Address - Country:US
Practice Address - Phone:405-341-4238
Practice Address - Fax:405-340-0269
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-17
Last Update Date:2011-01-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OK24243207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200056860AMedicaid
I30380Medicare UPIN
244523602Medicare ID - Type Unspecified