Provider Demographics
NPI:1184155129
Name:OGLESBY, CHRISTOPHER MICHEAL (DO)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:MICHEAL
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:CHRIS
Other - Middle Name:
Other - Last Name:OGLESBY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:611 GRAMMONT ST.
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-7516
Mailing Address - Country:US
Mailing Address - Phone:318-325-2634
Mailing Address - Fax:318-388-4177
Practice Address - Street 1:611 GRAMMONT ST.
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-7516
Practice Address - Country:US
Practice Address - Phone:318-325-2634
Practice Address - Fax:318-388-4177
Is Sole Proprietor?:No
Enumeration Date:2017-03-22
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA309959207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology