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Individual
LUIS A LOGRONO
Active
Individual
LUIS A LOGRONO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
ME67430
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
33310
BLUE SHIELD PALM HARBOR MEDICAL
FL
01
—
33864
BLUE SHIELD
FL
05
—
379686800
—
FL
01
—
5359105
AETNA
FL
01
—
9326165
AETNA GROUP #
FL
Enumeration date
10/21/2005
Last updated
04/01/2010
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