Provider Demographics
NPI:1770584773
Name:JOHN C OGLE DO PC
Entity type:Organization
Organization Name:JOHN C OGLE DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE COORD
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-548-1367
Mailing Address - Street 1:PO BOX 960242
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196
Mailing Address - Country:US
Mailing Address - Phone:580-548-1367
Mailing Address - Fax:580-548-1537
Practice Address - Street 1:401 E OKLAHOMA AVE
Practice Address - Street 2:STE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5800
Practice Address - Country:US
Practice Address - Phone:580-233-4353
Practice Address - Fax:580-233-2106
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty