Healthcare Provider Details

I. General information

NPI: 1659857043
Provider Name (Legal Business Name): JOHN OGE PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/18/2018
Last Update Date: 02/21/2022
Certification Date: 02/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2861 W 26TH ST
ERIE PA
16506-3064
US

IV. Provider business mailing address

2861 W 26TH ST
ERIE PA
16506-3064
US

V. Phone/Fax

Practice location:
  • Phone: 814-835-6695
  • Fax: 814-835-6699
Mailing address:
  • Phone: 814-835-6695
  • Fax: 814-835-6699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA060036
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberMA060036
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: