Provider Demographics
NPI:1013156538
Name:ANDREW G LOGAN MD PA
Entity Type:Organization
Organization Name:ANDREW G LOGAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-724-5100
Mailing Address - Street 1:7401 N UNIVERSITY DR
Mailing Address - Street 2:SUITE 201
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2979
Mailing Address - Country:US
Mailing Address - Phone:954-724-5100
Mailing Address - Fax:954-724-5121
Practice Address - Street 1:7401 N UNIVERSITY DR
Practice Address - Street 2:SUITE 201
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2979
Practice Address - Country:US
Practice Address - Phone:954-724-5100
Practice Address - Fax:954-724-5121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-05
Last Update Date:2010-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME58685207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty