Provider Demographics
NPI:1023081833
Name:COGDILL, DOUGLAS GLENN (MD)
Entity type:Individual
Prefix:
First Name:DOUGLAS
Middle Name:GLENN
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:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:1500 COOPER ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-2710
Practice Address - Country:US
Practice Address - Phone:817-347-9601
Practice Address - Fax:817-347-9602
Is Sole Proprietor?:No
Enumeration Date:2006-02-10
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL0094208M00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7221151OtherAETNA
TX752616977004OtherTRICARE CHAMPUS
TX89181GOtherBCBS OF TEXAS
TX089999902Medicaid
TXCO089181GOtherBCBS
TX123900OtherCHIPS
TX8089K2Medicare Oscar/Certification
G80961Medicare UPIN