Provider Demographics
NPI:1972508984
Name:OGE, BRIAN T (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:T
Last Name:OGE
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 905
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:71852-0905
Mailing Address - Country:US
Mailing Address - Phone:870-451-9199
Mailing Address - Fax:870-451-9442
Practice Address - Street 1:410 N MAIN ST
Practice Address - Street 2:STE 2
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-2000
Practice Address - Country:US
Practice Address - Phone:870-451-9199
Practice Address - Fax:870-451-9442
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-16
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3925207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR154132001Medicaid
AR5M901Medicare PIN
AR105349Medicare UPIN