Provider Demographics
NPI:1801837596
Name:FOGLEMAN, TRENT JAMES (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:JAMES
Last Name:FOGLEMAN
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 1:9617 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-6911
Mailing Address - Country:US
Mailing Address - Phone:337-522-1020
Mailing Address - Fax:405-692-2064
Practice Address - Street 1:9617 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-6911
Practice Address - Country:US
Practice Address - Phone:337-522-1020
Practice Address - Fax:405-692-2064
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-10
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.024189207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1574546Medicaid
LAH21592Medicare UPIN
LA4F010Medicare ID - Type UnspecifiedPROVIDER NUMBER