Provider Demographics
NPI:1306951306
Name:LOGE, ANNA SIRINA (MD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:SIRINA
Last Name:LOGE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MT HIGHWAY 91 S
Mailing Address - Street 2:
Mailing Address - City:DILLON
Mailing Address - State:MT
Mailing Address - Zip Code:59725-3535
Mailing Address - Country:US
Mailing Address - Phone:406-683-1188
Mailing Address - Fax:406-683-1142
Practice Address - Street 1:30 MT HIGHWAY 91 S
Practice Address - Street 2:
Practice Address - City:DILLON
Practice Address - State:MT
Practice Address - Zip Code:59725-3535
Practice Address - Country:US
Practice Address - Phone:406-683-1188
Practice Address - Fax:406-683-1142
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMT11350207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine