Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223S0112X | Oral and Maxillofacial Surgeon | D6888 | MN |
NPI | 1104868447 |
---|---|
Provider Name | Dr. Richard G Ogle |
First Address | Owatonna, MN 55060-3680 |
Second Address | Owatonna, MN 55060-3680 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0009976 | DORAL (01) | MN |
1009684 | PREFERRED ONE (01) | MN |
118127 | UCARE (01) | MN |
37056OG | BCBS (01) | MN |
T86069 | (02) | MN |