Provider Demographics
NPI:1922088731
Name:OGBURN, JAMES R JR (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:OGBURN
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:134 ROSEDALE DR
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:TX
Mailing Address - Zip Code:75751-3625
Mailing Address - Country:US
Mailing Address - Phone:903-675-0080
Mailing Address - Fax:903-675-0081
Practice Address - Street 1:134 ROSEDALE DR
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:TX
Practice Address - Zip Code:75751-3625
Practice Address - Country:US
Practice Address - Phone:903-675-0080
Practice Address - Fax:903-675-0081
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2011-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ2242207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8AG580OtherBCBS
TX00Y143OtherMEDICARE GROUP PTAN
TX1154445419OtherGROUP NPI NUMBER
TX8F6130OtherMEDICARE INDIVIDUAL PTAN
TXCL8659OtherMEDICARE CLINICALLAB PTAN