Provider Demographics
NPI:1659664746
Name:OGEDEGBE, JAMES O (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:O
Last Name:OGEDEGBE
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 1:514 E GRACE ST
Mailing Address - Street 2:
Mailing Address - City:PUNTA GORDA
Mailing Address - State:FL
Mailing Address - Zip Code:33950-6121
Mailing Address - Country:US
Mailing Address - Phone:941-639-1811
Mailing Address - Fax:941-639-0854
Practice Address - Street 1:1100 LOVELAND BLVD
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33980-1802
Practice Address - Country:US
Practice Address - Phone:941-624-7200
Practice Address - Fax:941-624-7200
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-23
Last Update Date:2011-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305R00000XManaged Care OrganizationsPreferred Provider Organization