Provider Demographics
NPI:1316184435
Name:OGLESBY, JAMES WILLIAM
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2340 AMPHIBIOUS DR. BLDG 2012 SUITE 125
Mailing Address - Street 2:COASTAL RIVERINE SQUADRON FOUR
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459
Mailing Address - Country:US
Mailing Address - Phone:757-462-3423
Mailing Address - Fax:
Practice Address - Street 1:2340 AMPHIBIOUS DR STE 125
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23459-8812
Practice Address - Country:US
Practice Address - Phone:757-462-3423
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-12
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman