Healthcare Provider Details

I. General information

NPI: 1922088731
Provider Name (Legal Business Name): JAMES R OGBURN JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 08/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

134 ROSEDALE DR
ATHENS TX
75751-3625
US

IV. Provider business mailing address

134 ROSEDALE DR
ATHENS TX
75751-3625
US

V. Phone/Fax

Practice location:
  • Phone: 903-675-0080
  • Fax: 903-675-0081
Mailing address:
  • Phone: 903-675-0080
  • Fax: 903-675-0081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberJ2242
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: