Healthcare Provider Details

I. General information

NPI: 1023399268
Provider Name (Legal Business Name): LYNN LAZARRE OGDEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2011
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3703 TEN BROECK WAY
LOUISVILLE KY
40241-2499
US

IV. Provider business mailing address

3703 TEN BROECK WAY
LOUISVILLE KY
40241-2499
US

V. Phone/Fax

Practice location:
  • Phone: 502-425-6403
  • Fax:
Mailing address:
  • Phone: 502-425-6403
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number14617
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: