Healthcare Provider Details

I. General information

NPI: 1366432247
Provider Name (Legal Business Name): JAMES EDWARD OGLESBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 W LOCKE ST STE C
ASHDOWN AR
71822-3326
US

IV. Provider business mailing address

6806 OAKLEAF LN
TEXARKANA AR
71854-8127
US

V. Phone/Fax

Practice location:
  • Phone: 903-276-8020
  • Fax: 870-898-4130
Mailing address:
  • Phone: 903-276-8020
  • Fax: 870-898-4130

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE3804
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: