Individual
LOGAN TAYLOR VANDER WOUDE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO, MPH
Contact information
Practice address
3500 US HIGHWAY 1, VERO BEACH, FL 32960-4511
(772) 299-1404
Mailing address
3500 US HIGHWAY 1, VERO BEACH, FL 32960-4511
(772) 299-1404
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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