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General NPI Number Information
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NPI Number | 1467940684
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Entity Type | Individual
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Provider Name | JACK GORDON OGILVIE MD
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Gender | Male
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Dates
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Enumeration Date | 04/23/2018
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Last Update Date | 07/01/2024
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Provider Practice Location Address
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Address Line | 350 W WILSON BRIDGE RD
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City | WORTHINGTON
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State | OH
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Zip | 43085-2585
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Country | US
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Telephone | 614-396-2684
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Fax |
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Provider Business Mailing Address
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Address Line | 701 TECH CENTER DR STE 250
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City | GAHANNA
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State | OH
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Zip | 43230-1987
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Country | US
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Telephone | 614-396-2684
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 35.150121
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License Number State | OH
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