Provider Demographics
NPI:1710549035
Name:ARBOGAST, LOGAN (PA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:ARBOGAST
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:890 E EAU GALLIE BLVD.
Mailing Address - Street 2:
Mailing Address - City:INDIAN HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:32937
Mailing Address - Country:US
Mailing Address - Phone:321-722-7295
Mailing Address - Fax:
Practice Address - Street 1:7000 H C KELLEY RD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32831-2518
Practice Address - Country:US
Practice Address - Phone:407-207-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-08
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant