Provider Demographics
NPI:1477617470
Name:ANNE D LOGAN MDPA
Entity type:Organization
Organization Name:ANNE D LOGAN MDPA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ANNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:830-816-5055
Mailing Address - Street 1:124 E BANDERA RD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-2849
Mailing Address - Country:US
Mailing Address - Phone:830-816-5055
Mailing Address - Fax:830-816-5056
Practice Address - Street 1:124 E BANDERA RD
Practice Address - Street 2:SUITE 304
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-2849
Practice Address - Country:US
Practice Address - Phone:830-816-5055
Practice Address - Fax:830-816-5056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2009-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ9170208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F50163Medicare UPIN
TX00X738Medicare PIN