Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | F7825 | TX |
Y | 2080P0214X | Pediatric Pulmonologist | F7825 | TX |
NPI | 1407963937 |
---|---|
Provider Name | Marie M. Logvinoff |
First Address | El Paso, TX 79995-9520 |
Second Address | El Paso, TX 79905-2709 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2006 |
Last Update Date | 17/11/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
138711012 | (05) | TX |
B24449 | (02) | TX |