Individual
MR. MARK P LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CPO
Contact information
Practice address
516 LAKEVIEW RD, VILLA 1, CLEARWATER, FL 33756-3302
(727) 449-9292
(727) 449-9393
Mailing address
2214 DONATO DR, BELLEAIR BEACH, FL 33786-3433
(727) 449-9292
(727) 449-9393
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
POR161
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00124
UNIVERSAL HEALTHCARE
FL
01
—
00178
QUALITY HEALTH CARE
FL
01
—
M0692
BLUE CROSS BLUE SHIELD
FL
Enumeration date
05/08/2007
Last updated
01/09/2008
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