Provider Demographics
NPI:1629246913
Name:COGDILL, LYNN DOYLE
Entity Type:Individual
Prefix:
First Name:LYNN
Middle Name:DOYLE
Last Name:COGDILL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 E RANKIN RD SPC 71
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-9106
Mailing Address - Country:US
Mailing Address - Phone:559-448-7794
Mailing Address - Fax:
Practice Address - Street 1:14427 ROAD 28
Practice Address - Street 2:
Practice Address - City:MADRA
Practice Address - State:CA
Practice Address - Zip Code:93638
Practice Address - Country:US
Practice Address - Phone:559-673-3508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-20
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT 28803247200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other