Healthcare Provider Details

I. General information

NPI: 1003887324
Provider Name (Legal Business Name): DAVID L OGDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 01/06/2021
Certification Date: 01/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

895 SIR FRANCIS DRAKE BLVD
SAN ANSELMO CA
94960-1916
US

IV. Provider business mailing address

PO BOX 6671
SANTA ROSA CA
95406-0671
US

V. Phone/Fax

Practice location:
  • Phone: 415-925-3596
  • Fax: 415-925-3597
Mailing address:
  • Phone: 707-544-7331
  • Fax: 707-948-6046

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG83692
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: