MEDICARE: MR. NELSON J LOGGIODICE PA

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
1	363A00000X	Physician Assistant	PA03948	TX

General Provider Information

NPI Number	:	1477551471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NELSON J LOGGIODICE PA

Provider Business Mailing Address
First Line	:	3908 N JACKSON RD
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-7768
Country	:	US
Telephone Number	:	956-502-5513
Fax Number	:	956-502-5514

Provider Business Practice Location Address
First Line	:	3908 N JACKSON RD
Second Line	:
City	:	PHARR
State	:	TX
Zip	:	78577-7768
Country	:	US
Telephone Number	:	956-502-5513
Fax Number	:	956-502-5514

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2005
Last Update Date	:	09/19/2011

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