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General NPI Number Information
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NPI Number | 1306958897
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Entity Type | Individual
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Provider Name | LOGAN K. BUNDY M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/31/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 533 SESPE AVE SUITE B
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City | FILLMORE
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State | CA
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Zip | 93015-1942
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Country | US
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Telephone | 805-524-6700
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Fax | 805-524-6707
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Provider Business Mailing Address
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Address Line | 533 SESPE AVE SUITE B
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City | FILLMORE
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State | CA
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Zip | 93015-1942
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Country | US
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Telephone | 805-524-6700
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Fax | 805-524-6707
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G30561
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License Number State | CA
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