Provider Demographics
NPI:1265412787
Name:OGLESBEE, JOHN H III (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:H
Last Name:OGLESBEE
Suffix:III
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 1:504 E HOSPITAL ST
Mailing Address - Street 2:
Mailing Address - City:SAN AUGUSTINE
Mailing Address - State:TX
Mailing Address - Zip Code:75972-2122
Mailing Address - Country:US
Mailing Address - Phone:936-275-9716
Mailing Address - Fax:936-275-9059
Practice Address - Street 1:504 E HOSPITAL ST
Practice Address - Street 2:
Practice Address - City:SAN AUGUSTINE
Practice Address - State:TX
Practice Address - Zip Code:75972-2122
Practice Address - Country:US
Practice Address - Phone:936-275-9716
Practice Address - Fax:936-275-9059
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2014-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG5444207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX115725701Medicaid
TX115725707Medicaid
TX00QB23Medicare ID - Type Unspecified
TX364443YM9KMedicare PIN
TX115725701Medicaid