Provider Demographics
NPI:1366432247
Name:OGLESBY, JAMES EDWARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:EDWARD
Last Name:OGLESBY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6806 OAKLEAF LN
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:AR
Mailing Address - Zip Code:71854-8127
Mailing Address - Country:US
Mailing Address - Phone:903-276-8020
Mailing Address - Fax:870-898-4130
Practice Address - Street 1:450 W LOCKE ST STE C
Practice Address - Street 2:
Practice Address - City:ASHDOWN
Practice Address - State:AR
Practice Address - Zip Code:71822-3326
Practice Address - Country:US
Practice Address - Phone:903-276-8020
Practice Address - Fax:870-898-4130
Is Sole Proprietor?:No
Enumeration Date:2005-10-24
Last Update Date:2017-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE3804207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR149691001Medicaid
AR5M514OtherBCBS
AR5M514OtherBCBS
H22049Medicare UPIN