Provider Demographics
NPI:1376515304
Name:OGLE, JOHN M JR
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:M
Last Name:OGLE
Suffix:JR
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 1:300 BETHESDA DR
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27834-7218
Mailing Address - Country:US
Mailing Address - Phone:252-752-7141
Mailing Address - Fax:252-752-0223
Practice Address - Street 1:300 BETHESDA DR
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27834-7218
Practice Address - Country:US
Practice Address - Phone:252-752-7141
Practice Address - Fax:252-752-0223
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200429208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89131XFMedicaid
NCH59694Medicare UPIN