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General NPI Number Information
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NPI Number | 1669685301
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Entity Type | Individual
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Provider Name | MARK P LOGUE CPO
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Gender | Male
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Dates
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Enumeration Date | 05/08/2007
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Last Update Date | 01/09/2008
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Provider Practice Location Address
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Address Line | 516 LAKEVIEW RD VILLA 1
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City | CLEARWATER
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State | FL
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Zip | 33756-3302
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Country | US
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Telephone | 727-449-9292
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Fax | 727-449-9393
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Provider Business Mailing Address
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Address Line | 2214 DONATO DR
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City | BELLEAIR BEACH
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State | FL
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Zip | 33786-3433
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Country | US
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Telephone | 727-449-9292
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Fax | 727-449-9393
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | POR161
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License Number State | FL
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