# ALONZO J LOGAN MD PA

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1679519417
- **Authorized official:** DR. ALONZO J LOGAN SR. MD (PST)
- **Authorized official phone:** (407) 846-3535

## Contact information

- **Practice address:** 102 PARK PL, STE D-1, KISSIMMEE, FL 34741
- **Practice address phone:** (407) 846-3535
- **Mailing address:** 102 PARK PL, STE D-1, KISSIMMEE, FL 34741
- **Mailing address phone:** (407) 846-3535

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 23726 | FL | Yes |

## Other

- **Enumeration date:** 06/21/2006
- **Last updated:** 08/22/2020