Healthcare Provider Details

I. General information

NPI: 1306039920
Provider Name (Legal Business Name): IPUOLE PAULINUS OGAR MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2007
Last Update Date: 10/31/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

IV. Provider business mailing address

5555 W THUNDERBIRD RD
GLENDALE AZ
85306-4622
US

V. Phone/Fax

Practice location:
  • Phone: 602-865-2627
  • Fax: 602-865-2632
Mailing address:
  • Phone: 602-865-2627
  • Fax: 602-865-2632

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number37444
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: