Organization
LOGAN INTERNAL MEDICINE GROUP
Active
Other names
Logan Internal Medicine Group
Organization subpart
No
Provider details
NPI number
Authorized official
FERNANDO LUIS GONZALEZ-RAMOS MD (CEO)
(304) 831-0450
Entity
Organization
Contact information
Practice address
77 HOSPITAL DRIVE, SUITE 101, LOGAN, WV 25601-3451
(304) 831-0450
(304) 831-0452
Mailing address
PO BOX 1617, LOGAN, WV 25601-1617
(304) 831-0450
(304) 831-0452
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001860338
BCBS OF MICHIGAN
—
05
—
3810011047
—
WV
01
—
438170
ADVANTRA FREEDOM
—
01
—
611399500
BLACK LUNG
—
01
—
DF2728
RR MEDICARE
WV
Enumeration date
06/29/2006
Last updated
02/10/2011
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