Provider Demographics
NPI:1902194871
Name:KOGER, CATHY LYNN (DO)
Entity Type:Individual
Prefix:DR
First Name:CATHY
Middle Name:LYNN
Last Name:KOGER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3434 47TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:CO
Mailing Address - Zip Code:80301-1817
Mailing Address - Country:US
Mailing Address - Phone:303-444-8100
Mailing Address - Fax:303-444-8113
Practice Address - Street 1:3434 47TH ST STE 200
Practice Address - Street 2:
Practice Address - City:BOULDER
Practice Address - State:CO
Practice Address - Zip Code:80301-1817
Practice Address - Country:US
Practice Address - Phone:303-444-8100
Practice Address - Fax:303-444-8113
Is Sole Proprietor?:No
Enumeration Date:2011-07-13
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO53663207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO53663OtherMEDICAL LICENSE