Individual
DR. AMANDA CASE LOGUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1214 COOLIDGE BLVD., SUITE C50, LAFAYETTE, LA 70503
(337) 237-7927
(337) 289-7935
Mailing address
PO BOX 62600 DEPT. 1721, NEW ORLEANS, LA 70162-2600
(337) 706-1605
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
203343
LA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1810941
—
LA
Enumeration date
04/11/2007
Last updated
05/01/2012
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