Provider Demographics
NPI:1477551471
Name:LOGGIODICE, NELSON J (PA)
Entity type:Individual
Prefix:MR
First Name:NELSON
Middle Name:J
Last Name:LOGGIODICE
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3908 N JACKSON RD
Mailing Address - Street 2:
Mailing Address - City:PHARR
Mailing Address - State:TX
Mailing Address - Zip Code:78577-7768
Mailing Address - Country:US
Mailing Address - Phone:956-502-5513
Mailing Address - Fax:956-502-5514
Practice Address - Street 1:3908 N JACKSON RD
Practice Address - Street 2:
Practice Address - City:PHARR
Practice Address - State:TX
Practice Address - Zip Code:78577-7768
Practice Address - Country:US
Practice Address - Phone:956-502-5513
Practice Address - Fax:956-502-5514
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03948363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant