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Individual
LOGAN ROBERT VIDAL
Active
Individual
LOGAN ROBERT VIDAL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
4347
IA
207Q00000X
Family Medicine Physician
Primary
OS12575
FL
207Q00000X
Family Medicine Physician
R-9308
IA
Other
Enumeration date
06/30/2011
Last updated
12/17/2019
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