Healthcare Provider Details

I. General information

NPI: 1316098429
Provider Name (Legal Business Name): EUGENE STANLEY OGROD M.D.,
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2007
Last Update Date: 02/05/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

526 KINGWOOD DR # 419
KINGWOOD TX
77339-4473
US

IV. Provider business mailing address

526 KINGWOOD DR # 419
KINGWOOD TX
77339-4473
US

V. Phone/Fax

Practice location:
  • Phone: 916-471-8303
  • Fax:
Mailing address:
  • Phone: 916-471-8303
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG20999
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: