Provider Demographics
NPI:1891322806
Name:LOGARBO, BRIAN PAUL JR (MD)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:PAUL
Last Name:LOGARBO
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8300 CONTANTIN BLVD.
Mailing Address - Street 2:2ND FLOOR ADMINISTRATION
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809
Mailing Address - Country:US
Mailing Address - Phone:225-374-1317
Mailing Address - Fax:225-374-1611
Practice Address - Street 1:8415 GOODWOOD BLVD
Practice Address - Street 2:SUITE 202
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806
Practice Address - Country:US
Practice Address - Phone:225-765-8013
Practice Address - Fax:225-765-2033
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-27
Last Update Date:2024-06-20
Deactivation Date:2024-05-09
Deactivation Code:
Reactivation Date:2024-06-18
Provider Licenses
StateLicense IDTaxonomies
390200000X
LA323070390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program