Healthcare Provider Details

I. General information

NPI: 1104447879
Provider Name (Legal Business Name): WILLIAM OGLESBY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/04/2020
Last Update Date: 08/07/2023
Certification Date: 08/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7301 MILWAUKEE AVE
LUBBOCK TX
79424-0626
US

IV. Provider business mailing address

7301 MILWAUKEE AVE
LUBBOCK TX
79424-0626
US

V. Phone/Fax

Practice location:
  • Phone: 806-761-0464
  • Fax: 806-698-6710
Mailing address:
  • Phone: 806-761-0464
  • Fax: 806-698-6710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberT6337
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: