Basic Information
| Provider Information | |||||||||
| NPI: | 1407276306 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OCHSNER | ||||||||
| FirstName: | MIMS | ||||||||
| MiddleName: | GAGE | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | III | ||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4425 PAULSEN ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314053662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123516615 | ||||||||
| FaxNumber: | 9123510645 | ||||||||
| Practice Location | |||||||||
| Address1: | 4425 PAULSEN ST | ||||||||
| Address2: | |||||||||
| City: | SAVANNAH | ||||||||
| State: | GA | ||||||||
| PostalCode: | 314053662 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9123516615 | ||||||||
| FaxNumber: | 9123510645 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2014 | ||||||||
| LastUpdateDate: | 09/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/11/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | MD.37991 | AL | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery |
No ID Information.