Healthcare Provider Details

I. General information

NPI: 1043523913
Provider Name (Legal Business Name): CHRIS JON OGLE P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2010
Last Update Date: 11/11/2020
Certification Date: 11/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1300 OAK STREET
FAULKTON SD
57438
US

IV. Provider business mailing address

39720 229TH ST
WOONSOCKET SD
57385-6604
US

V. Phone/Fax

Practice location:
  • Phone: 605-598-6262
  • Fax:
Mailing address:
  • Phone: 605-770-7879
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: