Provider Demographics
NPI:1265458681
Name:COGDILL, JASON MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:JASON
Middle Name:MATTHEW
Last Name:COGDILL
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 1:115 EIGHTH STREET NE
Mailing Address - Street 2:
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52401-1097
Mailing Address - Country:US
Mailing Address - Phone:319-363-3565
Mailing Address - Fax:319-363-4001
Practice Address - Street 1:115 EIGHTH STREET NE
Practice Address - Street 2:
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52401-1097
Practice Address - Country:US
Practice Address - Phone:319-363-3565
Practice Address - Fax:319-363-4001
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-15
Last Update Date:2013-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA40495207RN0300X
OH40495207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA40495OtherIOWA LICENSE NUMBER
OH99979OtherOHIO LICENSE NUMBER