Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0106X | Oral and Maxillofacial Pathology | 10564 | MO |
NPI | 1790833358 |
---|---|
Provider Name | Dr. Billy L Ogborn |
First Address | Cape Girardeau, MO 63703-4928 |
Second Address | Cape Girardeau, MO 63703-4928 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2007 |
Last Update Date | 08/07/2007 |