Provider Demographics
NPI:1669479853
Name:LOGSDON, MARK DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:DAVID
Last Name:LOGSDON
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:916-731-7877
Practice Address - Street 1:2825 CAPITOL AVE STE 502
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816
Practice Address - Country:US
Practice Address - Phone:916-454-6600
Practice Address - Fax:916-454-6618
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2018-07-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG846352085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G846350Medicare ID - Type Unspecified
G38983Medicare UPIN