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NPI Code Detail

MEDICARE: MATTHEW LOGAN

MEDICARE: MATTHEW LOGAN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1265394118
Entity Type Code : Individual
Provider Name (Legal Business Name) : MATTHEW LOGAN
Provider Business Mailing Address
First Line : 1700 S 23RD ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4803
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1700 S 23RD ST
Second Line :
City : FORT PIERCE
State : FL
Zip : 34950-4803
Country : US
Telephone Number : 772-468-4554
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/01/2025
Last Update Date : 05/21/2026

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Directions to “ MATTHEW LOGAN ” Practice Location

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