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NPI Code Detail

MEDICARE: DR. HARRY EDWARD LOGUE MD

MEDICARE: DR. HARRY EDWARD LOGUE MD
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
12084P0800XPsychiatry Physician5861AL

General Provider Information

NPI Number : 1861476640
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HARRY EDWARD LOGUE MD
Provider Business Mailing Address
First Line : 100 CENTURY PARK SOUTH
Second Line : SUITE 206
City : BIRMINGHAM
State : AL
Zip : 35226-3922
Country : US
Telephone Number : 205-978-7800
Fax Number : 205-978-7802
Provider Business Practice Location Address
First Line : 100 CENTURY PARK SOUTH
Second Line : SUITE 206
City : BIRMINGHAM
State : AL
Zip : 35226-3922
Country : US
Telephone Number : 205-978-7800
Fax Number : 205-978-7802
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2005
Last Update Date : 07/08/2007

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