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General NPI Number Information
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NPI Number | 1942462189
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Entity Type | Organization
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Legal Business Name | LOGAN BUNDY MD
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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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 | 93015-1985
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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
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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 | OWNER
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Name | MR. LOGAN KEITH BUNDY
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Credential | MD
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Telephone | 805-524-6700
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | G30561
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License Number State | CA
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