Provider Demographics
NPI:1689968729
Name:HOGAN, CHARLES ANDREW (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ANDREW
Last Name:HOGAN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2803 EARL RUDDER FWY S STE 103
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6099
Mailing Address - Country:US
Mailing Address - Phone:979-731-8888
Mailing Address - Fax:979-731-8935
Practice Address - Street 1:2803 EARL RUDDER FWY S STE 103
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6099
Practice Address - Country:US
Practice Address - Phone:979-731-8888
Practice Address - Fax:979-731-8935
Is Sole Proprietor?:No
Enumeration Date:2011-06-07
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK28579207X00000X
TXQ8906207XS0117X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK28579OtherSTATE MEDICAL LICENSE
TXQ8906OtherSTATE MEDICAL LICENSE
TX8XN356OtherBCBS PROVIDER ID