Basic Information
Provider Information
NPI: 1154497006
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: OGILVIE
FirstName: JAMES
MiddleName: W
NamePrefix:  
NameSuffix:  
Credential: M.D.
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Mailing Information
Address1: 3182 SILVER FRK
Address2:  
City: BRIGHTON
State: UT
PostalCode: 841219758
CountryCode: US
TelephoneNumber: 4356490632
FaxNumber:  
Practice Location
Address1: 1340 E. 300 N.
Address2: SHRINERS HOSPITAL FOR CHILDREN
City: SALT LAKE CITY
State: UT
PostalCode: 841034399
CountryCode: US
TelephoneNumber: 8015363600
FaxNumber: 8015363868
Other Information
ProviderEnumerationDate: 11/24/2006
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
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IsSoleProprietor: N
IsOrganizationSubpart:  
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AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207XP3100X150764-1205UTY Allopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery

No ID Information.


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