Provider Demographics
NPI:1245549468
Name:OGLE, DAVID WAYNE
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WAYNE
Last Name:OGLE
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 1:20406 W RAINBOW TRL
Mailing Address - Street 2:
Mailing Address - City:BUCKEYE
Mailing Address - State:AZ
Mailing Address - Zip Code:85326-4333
Mailing Address - Country:US
Mailing Address - Phone:623-386-7100
Mailing Address - Fax:
Practice Address - Street 1:20406 W RAINBOW TRL
Practice Address - Street 2:
Practice Address - City:BUCKEYE
Practice Address - State:AZ
Practice Address - Zip Code:85326-4333
Practice Address - Country:US
Practice Address - Phone:623-386-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-05
Last Update Date:2010-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant