Healthcare Provider Details

I. General information

NPI: 1790231470
Provider Name (Legal Business Name): SUSAN M OGDEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 07/28/2023
Certification Date: 12/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10010 WESTOVER HILLS BLVD STE 125
SAN ANTONIO TX
78251-1968
US

IV. Provider business mailing address

11212 HIGHWAY 151 STE 1 SUITE 240
SAN ANTONIO TX
78251-4499
US

V. Phone/Fax

Practice location:
  • Phone: 210-682-9434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10735
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: