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General NPI Number Information
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NPI Number | 1821213067
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Entity Type | Individual
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Provider Name | BRADLEY SCOTT LOGAN M.D.
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Gender | Male
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Dates
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Enumeration Date | 04/14/2007
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Last Update Date | 09/19/2025
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Provider Practice Location Address
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Address Line | 22299 STATE ROAD 54 STE 105
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City | LUTZ
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State | FL
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Zip | 33549-6942
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Country | US
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Telephone | 813-333-1516
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Fax |
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Provider Business Mailing Address
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Address Line | 22299 STATE ROAD 54 STE 105
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City | LUTZ
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State | FL
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Zip | 33549-6942
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Country | US
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Telephone | 813-739-9063
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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 | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD48929
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License Number State | AL
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Taxonomy #2
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number | MD0000030054
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD0000030054
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | ME140190
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License Number State | FL
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