Provider Demographics
NPI:1689909681
Name:OGBEIDE, PATRICK E
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:E
Last Name:OGBEIDE
Suffix:
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 1:3002 WESTSHORE DR
Mailing Address - Street 2:
Mailing Address - City:ROWLETT
Mailing Address - State:TX
Mailing Address - Zip Code:75088-5695
Mailing Address - Country:US
Mailing Address - Phone:214-725-5080
Mailing Address - Fax:469-366-7699
Practice Address - Street 1:3002 WESTSHORE DR
Practice Address - Street 2:
Practice Address - City:ROWLETT
Practice Address - State:TX
Practice Address - Zip Code:75088-5695
Practice Address - Country:US
Practice Address - Phone:214-725-5080
Practice Address - Fax:469-366-7699
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX010833251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
747121Medicare Oscar/Certification