Provider Demographics
NPI:1689995870
Name:SCHNEIDER, LOGAN DOUGLAS (MD)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:DOUGLAS
Last Name:SCHNEIDER
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 1:450 BROADWAY ST # MC5704
Mailing Address - Street 2:PAVILION C, 2ND FLOOR
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-3132
Mailing Address - Country:US
Mailing Address - Phone:650-721-7575
Mailing Address - Fax:650-721-3468
Practice Address - Street 1:450 BROADWAY ST # MC5704
Practice Address - Street 2:PAVILION C, 2ND FLOOR
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-3132
Practice Address - Country:US
Practice Address - Phone:650-721-7575
Practice Address - Fax:650-721-3468
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-22
Last Update Date:2015-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLTRN15244207R00000X
CAA1294542084N0400X, 2084S0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No2084S0012XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologySleep Medicine