Provider Demographics
NPI:1194778258
Name:OGLETREE, CARL W (MD)
Entity type:Individual
Prefix:DR
First Name:CARL
Middle Name:W
Last Name:OGLETREE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:PO BOX 1400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77251-1400
Mailing Address - Country:US
Mailing Address - Phone:713-351-0644
Mailing Address - Fax:713-351-0633
Practice Address - Street 1:15200 SOUTHWEST FWY
Practice Address - Street 2:SUITE 380
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3845
Practice Address - Country:US
Practice Address - Phone:281-565-3569
Practice Address - Fax:281-565-1911
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2011-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3629208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034553001Medicaid
TX034553001Medicaid
TX8F3159Medicare PIN