Provider Demographics
NPI:1386687242
Name:KOGER, LINTON M (MD)
Entity Type:Individual
Prefix:
First Name:LINTON
Middle Name:M
Last Name:KOGER
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:PO BOX 957
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75403-0957
Mailing Address - Country:US
Mailing Address - Phone:903-408-7750
Mailing Address - Fax:903-408-7802
Practice Address - Street 1:4211 JOE RAMSEY BLVD E
Practice Address - Street 2:SUITE 100
Practice Address - City:GREENVILLE
Practice Address - State:TX
Practice Address - Zip Code:75401-7852
Practice Address - Country:US
Practice Address - Phone:903-408-7750
Practice Address - Fax:903-408-7802
Is Sole Proprietor?:No
Enumeration Date:2006-06-14
Last Update Date:2022-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5589207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX117123303Medicaid
TX8145K0OtherBLUE CROSS BLUE SHIELD
TXK5589Medicare UPIN
TX8145K0OtherBLUE CROSS BLUE SHIELD
TX8145K0Medicare PIN