Provider Demographics
NPI:1598791774
Name:ALBERT G LOGUN M D HUBERT G MARTINEZ M D P A
Entity Type:Organization
Organization Name:ALBERT G LOGUN M D HUBERT G MARTINEZ M D P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JORGE
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:DIAZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-821-6112
Mailing Address - Street 1:7100 W 20TH AVE STE 401
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-1811
Mailing Address - Country:US
Mailing Address - Phone:305-821-6112
Mailing Address - Fax:305-821-9050
Practice Address - Street 1:7100 W 20TH AVE STE 401
Practice Address - Street 2:
Practice Address - City:HIALEAH
Practice Address - State:FL
Practice Address - Zip Code:33016-1811
Practice Address - Country:US
Practice Address - Phone:305-821-6112
Practice Address - Fax:305-821-6112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7912207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL019928600Medicaid
FL019928600Medicaid
FL98109Medicare ID - Type Unspecified