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General NPI Number Information
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NPI Number | 1942433552
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Entity Type | Organization
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Legal Business Name | DAVID J OGLE MD PC
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Dates
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Enumeration Date | 08/29/2009
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Last Update Date | 07/21/2010
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Provider Practice Location Address
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Address Line | 5500 SE 22ND ST
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City | GRESHAM
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State | OR
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Zip | 97080-8170
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Country | US
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Telephone | 503-663-3075
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Fax | 503-663-3075
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Provider Business Mailing Address
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Address Line | 5500 SE 22ND ST
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City | GRESHAM
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State | OR
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Zip | 97080-8170
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Country | US
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Telephone | 503-663-3075
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Fax | 503-663-3075
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DAVID JEFFREY OGLE
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Credential | MD
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Telephone | 503-663-3075
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | MD20318
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License Number State | OR
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