Healthcare Provider Details

I. General information

NPI: 1063407708
Provider Name (Legal Business Name): OLEGARIO J IGNACIO JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2005
Last Update Date: 04/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 WALL ST SUITE 207
JEFFERSONVILLE IN
47130-3612
US

IV. Provider business mailing address

1035 WALL ST STE 207
JEFFERSONVILLE IN
47130-3612
US

V. Phone/Fax

Practice location:
  • Phone: 812-282-1351
  • Fax: 812-283-5758
Mailing address:
  • Phone: 812-282-1351
  • Fax: 812-283-5758

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number26117
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: