Provider Demographics
NPI:1689719346
Name:OGLESBY, JAMES EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:EDWIN
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:201 HILDA ST
Mailing Address - Street 2:SUITE 30
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-2320
Mailing Address - Country:US
Mailing Address - Phone:407-846-4877
Mailing Address - Fax:407-846-4802
Practice Address - Street 1:201 HILDA ST
Practice Address - Street 2:STE 30
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-2320
Practice Address - Country:US
Practice Address - Phone:407-846-4877
Practice Address - Fax:407-846-4802
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2010-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME18318207Q00000X, 208600000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLD55550Medicare UPIN
FL49024Medicare ID - Type Unspecified