Provider Demographics
NPI:1265714836
Name:GARY A. OGIN, MD, PA
Entity type:Organization
Organization Name:GARY A. OGIN, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TINA
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIDOVICH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-232-1300
Mailing Address - Street 1:363 W FORK
Mailing Address - Street 2:APT. 1215
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75039-6229
Mailing Address - Country:US
Mailing Address - Phone:817-421-9111
Mailing Address - Fax:
Practice Address - Street 1:700 E SOUTHLAKE BLVD
Practice Address - Street 2:STE. 130
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6353
Practice Address - Country:US
Practice Address - Phone:817-421-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-09
Last Update Date:2011-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG9176208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty