Provider Demographics
NPI:1225062862
Name:GOGOL, LYNETTE M (DO)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:M
Last Name:GOGOL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2225 COUNTY RD 90
Mailing Address - Street 2:SUITE 107
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584-4891
Mailing Address - Country:US
Mailing Address - Phone:281-485-2337
Mailing Address - Fax:281-485-2985
Practice Address - Street 1:2225 COUNTY RD 90
Practice Address - Street 2:SUITE 107
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584-4891
Practice Address - Country:US
Practice Address - Phone:281-485-2337
Practice Address - Fax:281-485-2985
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2012-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL22812084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXTXB140964Medicare PIN
TX8F1881Medicare ID - Type Unspecified
TXI33192Medicare UPIN
TX8G3621Medicare ID - Type Unspecified