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General NPI Number Information
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NPI Number | 1487888483
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Entity Type | Individual
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Provider Name | HILARY BETH LOGE M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 02/11/2022
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Provider Practice Location Address
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Address Line | 101 BODIN CIR FL CLINIC3
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City | TRAVIS AFB
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State | CA
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Zip | 94535-1809
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Country | US
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Telephone | 916-843-9224
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Fax |
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Provider Business Mailing Address
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Address Line | 101 BODIN CIRCLE GENERAL SURGERY CLINIC, 3RD FLOOR, DGMC
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City | TRAVIS AFB
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State | CA
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Zip | 94535
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Country | US
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Telephone |
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Fax |
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | A113749
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License Number State | CA
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