Provider Demographics
NPI:1649254400
Name:OGBURN, DAVID H (MD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:H
Last Name:OGBURN
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 5278
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32247-5278
Mailing Address - Country:US
Mailing Address - Phone:904-398-3356
Mailing Address - Fax:904-398-5397
Practice Address - Street 1:820 PRUDENTIAL DR
Practice Address - Street 2:SUITE 606
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-8210
Practice Address - Country:US
Practice Address - Phone:904-398-3356
Practice Address - Fax:904-398-5397
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2011-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0038064207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL067207600Medicaid
FLD54238Medicare UPIN
FL31141ZMedicare ID - Type Unspecified