Provider Demographics
NPI:1053330134
Name:OGG, BRIAN GEOFFREY (DO)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:GEOFFREY
Last Name:OGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5300 N INDEPENDENCE AVE
Mailing Address - Street 2:SUITE 280
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-5556
Mailing Address - Country:US
Mailing Address - Phone:580-213-9799
Mailing Address - Fax:580-234-2474
Practice Address - Street 1:2821 N VAN BUREN ST
Practice Address - Street 2:SUITE A
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73703-1729
Practice Address - Country:US
Practice Address - Phone:580-213-9799
Practice Address - Fax:580-234-2474
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3827207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100747570AMedicaid
OK200102260AMedicaid
OK200102260AMedicaid
OK100747570AMedicaid
400522488Medicare PIN
P00373267Medicare PIN
OKH38555Medicare UPIN