Basic Information
| Provider Information | |||||||||
| NPI: | 1528077948 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OGAN | ||||||||
| FirstName: | BRIAN | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | C/O CROSSROADS BANK | ||||||||
| Address2: | PO BOX 783 | ||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624019906 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472332 | ||||||||
| FaxNumber: | 2173472313 | ||||||||
| Practice Location | |||||||||
| Address1: | 1303 W EVERGREEN AVE STE 201 | ||||||||
| Address2: | |||||||||
| City: | EFFINGHAM | ||||||||
| State: | IL | ||||||||
| PostalCode: | 624011638 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2173472332 | ||||||||
| FaxNumber: | 2173472313 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/05/2006 | ||||||||
| LastUpdateDate: | 01/25/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/25/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 336-067076 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207L00000X | 036101808 | IL | N | Allopathic & Osteopathic Physicians | Anesthesiology | 207LP2900X | 036-101808 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.