Individual
LOGAN TAYLOR VANDER WOUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
OS17574
FL
207W00000X
Ophthalmology Physician
Primary
OS17574
FL
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OS17574
MEDICAL LICENSE
FL
Enumeration date
04/15/2017
Last updated
09/16/2022
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