Healthcare Provider Details

I. General information

NPI: 1225062862
Provider Name (Legal Business Name): LYNETTE M GOGOL D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2006
Last Update Date: 01/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2225 COUNTY RD 90 SUITE 107
PEARLAND TX
77584-4891
US

IV. Provider business mailing address

2225 COUNTY RD 90 SUITE 107
PEARLAND TX
77584-4891
US

V. Phone/Fax

Practice location:
  • Phone: 281-485-2337
  • Fax: 281-485-2985
Mailing address:
  • Phone: 281-485-2337
  • Fax: 281-485-2985

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberL2281
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: