Provider Demographics
NPI:1023399268
Name:OGDEN, LYNN LAZARRE (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNN
Middle Name:LAZARRE
Last Name:OGDEN
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 1:3703 TEN BROECK WAY
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40241-2499
Mailing Address - Country:US
Mailing Address - Phone:502-425-6403
Mailing Address - Fax:
Practice Address - Street 1:3703 TEN BROECK WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40241-2499
Practice Address - Country:US
Practice Address - Phone:502-425-6403
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-01
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY14617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY14617Other14617,KY LICENSE