Healthcare Provider Details

I. General information

NPI: 1720072788
Provider Name (Legal Business Name): ALAN DONALD OGLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/07/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 5210 BOX 230
APO AE
09461-0230
GB

IV. Provider business mailing address

PSC 47 BOX 785
APO AE
09470
GB

V. Phone/Fax

Practice location:
  • Phone: 011441487811039
  • Fax: 011441487811040
Mailing address:
  • Phone: 011441487811039
  • Fax: 011441487811040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number391
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: