Provider Demographics
NPI:1669494548
Name:OGEDA, FIDEL LOPEZ (MD)
Entity Type:Individual
Prefix:
First Name:FIDEL
Middle Name:LOPEZ
Last Name:OGEDA
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:PO BOX 8148
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79708-8148
Mailing Address - Country:US
Mailing Address - Phone:432-689-6818
Mailing Address - Fax:432-689-6901
Practice Address - Street 1:4506 BRIARWOOD AVE STE A
Practice Address - Street 2:
Practice Address - City:MIDLAND
Practice Address - State:TX
Practice Address - Zip Code:79707-2642
Practice Address - Country:US
Practice Address - Phone:432-689-6818
Practice Address - Fax:432-689-6901
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2018-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3675207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX185734404Medicaid
TXP00750200OtherMEDICARE RAILROAD