Healthcare Provider Details

I. General information

NPI: 1164699328
Provider Name (Legal Business Name): ROBERT B OGESEN II M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/15/2008
Last Update Date: 11/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15215 S 48TH ST STE 152
PHOENIX AZ
85044
US

IV. Provider business mailing address

15215 S 48TH ST STE 152
PHOENIX AZ
85044
US

V. Phone/Fax

Practice location:
  • Phone: 480-704-8585
  • Fax: 480-704-8668
Mailing address:
  • Phone: 480-704-8585
  • Fax: 480-704-8668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number20679
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: