MEDICARE: DR. RONALD V LOGE M.D.

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	207RG0300X	Geriatric Medicine (Internal Medicine) Physician	4484	MT

General Provider Information

NPI Number	:	1790789279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD V LOGE M.D.

Provider Business Mailing Address
First Line	:	30 HWY 91 S #103
Second Line	:
City	:	DILLON
State	:	MT
Zip	:	59725
Country	:	US
Telephone Number	:	406-683-6861
Fax Number	:	406-683-1180

Provider Business Practice Location Address
First Line	:	30 HWY 91 S #103
Second Line	:
City	:	DILLON
State	:	MT
Zip	:	59725
Country	:	US
Telephone Number	:	406-683-6861
Fax Number	:	406-683-1180

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

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	07/08/2007

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