Provider Demographics
NPI:1275536989
Name:LOGEL, ROBERT JOHN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:LOGEL
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 87089
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-7089
Mailing Address - Country:US
Mailing Address - Phone:910-484-3114
Mailing Address - Fax:910-484-8824
Practice Address - Street 1:1991 FORDHAM DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304
Practice Address - Country:US
Practice Address - Phone:910-484-3114
Practice Address - Fax:910-484-8824
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-03-11
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Provider Licenses
StateLicense IDTaxonomies
NC21071207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC8952488Medicaid
NCC85200Medicare UPIN
NC8952488Medicaid