Provider Demographics
NPI:1730528852
Name:VOGL, PAIGE C (RD, CDE)
Entity type:Individual
Prefix:
First Name:PAIGE
Middle Name:C
Last Name:VOGL
Suffix:
Gender:F
Credentials:RD, CDE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W MAGNOLIA AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76104-8518
Mailing Address - Country:US
Mailing Address - Phone:817-921-6166
Mailing Address - Fax:817-921-9594
Practice Address - Street 1:900 W MAGNOLIA AVE STE 201
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-8518
Practice Address - Country:US
Practice Address - Phone:817-921-6166
Practice Address - Fax:817-921-9594
Is Sole Proprietor?:No
Enumeration Date:2013-06-21
Last Update Date:2013-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03625133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX311900YMNTMedicare PIN