Provider Demographics
NPI:1437244571
Name:LOGRONIO, JESUS M (MD)
Entity Type:Individual
Prefix:DR
First Name:JESUS
Middle Name:M
Last Name:LOGRONIO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 878
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0878
Mailing Address - Country:US
Mailing Address - Phone:689-698-3720
Mailing Address - Fax:689-698-3720
Practice Address - Street 1:9857 OLD ST. AUGUSTINE RD
Practice Address - Street 2:SUITE 1
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32257
Practice Address - Country:US
Practice Address - Phone:904-260-4461
Practice Address - Fax:904-292-9684
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-09-20
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Provider Licenses
StateLicense IDTaxonomies
FLME48374207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE22586Medicare UPIN