Provider Demographics
NPI:1326099300
Name:LOGAS, PAUL C (MD)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:C
Last Name:LOGAS
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 1:1500 SE 17TH ST
Mailing Address - Street 2:600
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34471-4621
Mailing Address - Country:US
Mailing Address - Phone:352-732-8955
Mailing Address - Fax:352-732-7999
Practice Address - Street 1:1500 SE 17TH ST
Practice Address - Street 2:600
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-4621
Practice Address - Country:US
Practice Address - Phone:352-732-8955
Practice Address - Fax:352-732-7999
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME00553202080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F00119Medicare UPIN