1487631511 NPI number — BRUCE OGIN DO

Table of content: BRUCE OGIN DO (NPI 1487631511)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487631511 NPI number — BRUCE OGIN DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
OGIN
Provider First Name:
BRUCE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487631511
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 499
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80291-0499
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
303-336-8304
Provider Business Mailing Address Fax Number:
303-780-0787

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
455 SHERMAN
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
DENVER
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80203-4405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
303-336-8304
Provider Business Practice Location Address Fax Number:
303-780-0787
Provider Enumeration Date:
12/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  18217 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 841134385-13 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3506685 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100271470A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1075306-00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 058688501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: L5024 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01182179 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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