Provider Demographics
NPI:1629294004
Name:SONDRUP, LOGAN COLE (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:COLE
Last Name:SONDRUP
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8670 W CHEYENNE AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-7456
Mailing Address - Country:US
Mailing Address - Phone:702-576-9608
Mailing Address - Fax:702-576-9609
Practice Address - Street 1:8670 W CHEYENNE AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89129-7456
Practice Address - Country:US
Practice Address - Phone:702-576-9608
Practice Address - Fax:702-576-9609
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2013-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
146D00000X
NV13613207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No146D00000XEmergency Medical Service ProvidersPersonal Emergency Response Attendant