Provider Demographics
NPI:1609803980
Name:OGDEN, LIDA J (MD)
Entity Type:Individual
Prefix:
First Name:LIDA
Middle Name:J
Last Name:OGDEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 W UNIVERSITY PKWY
Mailing Address - Street 2:
Mailing Address - City:OREM
Mailing Address - State:UT
Mailing Address - Zip Code:84058-7316
Mailing Address - Country:US
Mailing Address - Phone:801-234-8600
Mailing Address - Fax:
Practice Address - Street 1:145 W UNIVERSITY PKWY
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84058-7316
Practice Address - Country:US
Practice Address - Phone:801-234-8600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2021-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7357411-1205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine