Healthcare Provider Details

I. General information

NPI: 1457611709
Provider Name (Legal Business Name): SERAH O OGUN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2012
Last Update Date: 12/31/2019
Certification Date: 12/31/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1421 N HIGHWAY 67 STE 200
CEDAR HILL TX
75104-4019
US

IV. Provider business mailing address

1421 N HIGHWAY 67 STE 200
CEDAR HILL TX
75104-4019
US

V. Phone/Fax

Practice location:
  • Phone: 469-251-2850
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberBP1-0044180
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberQ0328
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: