Healthcare Provider Details

I. General information

NPI: 1053330134
Provider Name (Legal Business Name): BRIAN GEOFFREY OGG D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 04/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2821 N VAN BUREN ST SUITE A
ENID OK
73703-1729
US

IV. Provider business mailing address

5300 N INDEPENDENCE AVE SUITE 280
OKLAHOMA CITY OK
73112-5556
US

V. Phone/Fax

Practice location:
  • Phone: 580-213-9799
  • Fax: 580-234-2474
Mailing address:
  • Phone: 580-213-9799
  • Fax: 580-234-2474

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number3827
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: