Individual
MARTIN THOMAS LOGSDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1700 BLUEGRASS AVENUE, SUITE 300, LOUISVILLE, KY 40215
(502) 363-1841
(502) 366-3317
Mailing address
1700 BLUEGRASS AVENUE, SUITE 300, LOUISVILLE, KY 40215
(502) 363-1841
(502) 366-3317
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
20406
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000047754
ANTHEM
—
01
—
1069483
PASSPORT
—
05
—
64204068
—
KY
Enumeration date
05/15/2006
Last updated
08/16/2011
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