Active NPI
Neal W Mogk, MD
- Family Medicine Physician
- Flagstaff, AZ
National Provider Identifier
1508919945
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Family Medicine Physician
- License
- 17321
- Practice address
- 107 E Oak Ave
Flagstaff, AZ 86001-1818 - Phone
- (928) 913-8800
- Fax
- (928) 913-8801
- NPI assigned
- Jan 19, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 17321 | AZ | Primary |
Addresses
Primary practice location
107 E Oak Ave
Flagstaff, AZ 86001-1818
Mailing address
1200 N Beaver St
Flagstaff, AZ 86001-3118
Phone (928) 213-6235
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 277477 | Medicaid | AZ | |
| AZ0848210 | Other | AZ | BCBS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17321 | AZ | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1169164800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1633651200000",
"number": "1508919945",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1200 N BEAVER ST",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860013118",
"telephone_number": "928-213-6235",
"fax_number": "928-213-6292"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "107 E OAK AVE",
"city": "FLAGSTAFF",
"state": "AZ",
"postal_code": "860011818",
"telephone_number": "928-913-8800",
"fax_number": "928-913-8801"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOGK",
"first_name": "NEAL",
"middle_name": "W",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-19",
"last_updated": "2021-10-08",
"certification_date": "2021-10-08",
"status": "A"
},
"taxonomies": [
{
"code": "207Q00000X",
"taxonomy_group": "",
"desc": "Family Medicine",
"state": "AZ",
"license": "17321",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "277477",
"state": "AZ"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS",
"identifier": "AZ0848210",
"state": "AZ"
}
],
"endpoints": [],
"other_names": []
}Other providers in Flagstaff, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.