Provider Demographics
NPI:1043248628
Name:LOGAGLIO, PHILIPPE J (MD)
Entity Type:Individual
Prefix:DR
First Name:PHILIPPE
Middle Name:J
Last Name:LOGAGLIO
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 1:1504 SPRING HILL AVE
Mailing Address - Street 2:VA OUTPATIENT CLINIC MOPC
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36604-3207
Mailing Address - Country:US
Mailing Address - Phone:251-219-3900
Mailing Address - Fax:
Practice Address - Street 1:1504 SPRING HILL AVE
Practice Address - Street 2:VA OUTPATIENT CLINIC MOPC
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36604-3207
Practice Address - Country:US
Practice Address - Phone:251-219-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA05493R207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1343731Medicaid
LA1343731Medicaid
LA5L844Medicare ID - Type Unspecified