Healthcare Provider Details

I. General information

NPI: 1508862525
Provider Name (Legal Business Name): WILLIAM DAVIDSON OGDEN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6800 IH10 WEST STE 300
SAN ANTONIO TX
78201-2011
US

IV. Provider business mailing address

326 PASEO ENCINAL ST
SAN ANTONIO TX
78212-1708
US

V. Phone/Fax

Practice location:
  • Phone: 210-616-0008
  • Fax: 210-616-0231
Mailing address:
  • Phone: 210-822-1178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License NumberF4336
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: