Provider Demographics
NPI:1043222821
Name:OGDEN, RICHARD J (MS, LMT)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:J
Last Name:OGDEN
Suffix:
Gender:M
Credentials:MS, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3919 SW 21ST ST
Mailing Address - Street 2:SUITE D
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3317
Mailing Address - Country:US
Mailing Address - Phone:352-538-4603
Mailing Address - Fax:352-335-3939
Practice Address - Street 1:2411 NW 41ST ST
Practice Address - Street 2:SUITE D
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32606-7499
Practice Address - Country:US
Practice Address - Phone:352-538-4603
Practice Address - Fax:352-335-3939
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMA44043225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLC3980OtherBCBS PROVIDER NUMBER