Provider Demographics
NPI:1205826203
Name:OGAWA, GREGORY SH (MD)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:SH
Last Name:OGAWA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8801 HORIZON BLVD NE
Mailing Address - Street 2:SUITE 360
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-1533
Mailing Address - Country:US
Mailing Address - Phone:505-828-4923
Mailing Address - Fax:505-213-0103
Practice Address - Street 1:5757 HARPER DRIVE NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109
Practice Address - Country:US
Practice Address - Phone:505-888-5757
Practice Address - Fax:505-889-3589
Is Sole Proprietor?:No
Enumeration Date:2005-10-21
Last Update Date:2012-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM94-348207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM17514Medicaid
AZ360777Medicaid
NMNM004572OtherBC BS OF NM
NM180033531OtherRRB MEDICARE RAILROAD
NM180033531OtherRRB MEDICARE RAILROAD