Provider Demographics
NPI:1235390634
Name:RICHARDS, LOGAN MCCANN (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:MCCANN
Last Name:RICHARDS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2896 GULF BREEZE PKWY
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-3146
Mailing Address - Country:US
Mailing Address - Phone:850-908-3310
Mailing Address - Fax:850-934-0050
Practice Address - Street 1:2896 GULF BREEZE PKWY
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-3146
Practice Address - Country:US
Practice Address - Phone:850-908-3310
Practice Address - Fax:850-934-0050
Is Sole Proprietor?:No
Enumeration Date:2008-06-19
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFH114YMedicare PIN