MEDICARE: DR. DAVID L OGDEN M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G83692	CA

General Provider Information

NPI Number	:	1003887324
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID L OGDEN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 6671
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95406-0671
Country	:	US
Telephone Number	:	707-544-7331
Fax Number	:	707-948-6046

Provider Business Practice Location Address
First Line	:	895 SIR FRANCIS DRAKE BLVD
Second Line	:
City	:	SAN ANSELMO
State	:	CA
Zip	:	94960-1916
Country	:	US
Telephone Number	:	415-925-3596
Fax Number	:	415-925-3597

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/27/2006
Last Update Date	:	01/06/2021

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