Provider Demographics
NPI:1558430157
Name:LOGAN, ANDREW GARDNER (MD)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:GARDNER
Last Name:LOGAN
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 1:7401 N UNIVERSITY DR
Mailing Address - Street 2:#206
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2979
Mailing Address - Country:US
Mailing Address - Phone:954-724-5100
Mailing Address - Fax:954-724-5121
Practice Address - Street 1:7401 N UNIVERSITY DR
Practice Address - Street 2:#206
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2979
Practice Address - Country:US
Practice Address - Phone:954-724-5100
Practice Address - Fax:954-724-5121
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0058685207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
11492Medicare ID - Type Unspecified