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General NPI Number Information
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NPI Number | 1659664746
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Entity Type | Individual
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Provider Name | JAMES O OGEDEGBE MD
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Gender | Male
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Dates
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Enumeration Date | 05/23/2011
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Last Update Date | 05/23/2011
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Provider Practice Location Address
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Address Line | 1100 LOVELAND BLVD
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City | PORT CHARLOTTE
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State | FL
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Zip | 33980-1802
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Country | US
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Telephone | 941-624-7200
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Fax | 941-624-7200
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Provider Business Mailing Address
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Address Line | 514 E GRACE ST
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City | PUNTA GORDA
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State | FL
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Zip | 33950-6121
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Country | US
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Telephone | 941-639-1811
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Fax | 941-639-0854
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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 | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number |
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License Number State |
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