Individual
MATTHEW LOGUE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
2009 MOSSY COVE, BRANDON, MS 39042
(601) 519-7766
Mailing address
2009 MOSSY CV, BRANDON, MS 39042-2091
(601) 519-7766
Taxonomy
Speciality
Code
Description
License number
State
172V00000X
Community Health Worker
Primary
—
MS
Other
Enumeration date
06/07/2016
Last updated
06/07/2016
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