Healthcare Provider Details

I. General information

NPI: 1437412210
Provider Name (Legal Business Name): SUSAN M OGDEN-MCKEE PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 05/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 W EAGLE DR
DECATUR TX
76234-3745
US

IV. Provider business mailing address

1001 W EAGLE DR
DECATUR TX
76234-3745
US

V. Phone/Fax

Practice location:
  • Phone: 940-627-7440
  • Fax: 940-627-7464
Mailing address:
  • Phone: 940-627-7440
  • Fax: 940-627-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberPA07911
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: