Healthcare Provider Details

I. General information

NPI: 1891720777
Provider Name (Legal Business Name): MARK T OGDEN DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 12/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 DALLAS ST EMERGENCY ROOM
SAN ANTONIO TX
78205-1201
US

IV. Provider business mailing address

PO BOX 12740
WESTMINSTER CA
92685-2740
US

V. Phone/Fax

Practice location:
  • Phone: 210-614-0180
  • Fax: 210-615-7170
Mailing address:
  • Phone: 562-468-0227
  • Fax: 562-467-0865

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberM4406
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207PE0004X
TaxonomyEmergency Medical Services (Emergency Medicine) Physician
License NumberM4406
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: