Provider Demographics
NPI:1861438004
Name:BOGAARD, THOMAS PAUL (MD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:PAUL
Last Name:BOGAARD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1004
Mailing Address - Street 2:
Mailing Address - City:SIERRA MADRE
Mailing Address - State:CA
Mailing Address - Zip Code:91025-4004
Mailing Address - Country:US
Mailing Address - Phone:818-378-1025
Mailing Address - Fax:626-795-3229
Practice Address - Street 1:1401 S GRAND AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90015-3010
Practice Address - Country:US
Practice Address - Phone:213-802-0100
Practice Address - Fax:626-795-3229
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG21222208800000X, 174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G21220Medicaid
CARHD113967OtherX-RAY LC
CA00G21220OtherCCS
CA05D0726009OtherCLIA NO
CA05D0726009OtherCLIA NO
CA00G21220OtherCCS
CARHD113967OtherX-RAY LC
CA05D0726009OtherCLIA NO