BRIAN J LOGUE (NPI# 1467450767) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1467450767 |
| Entity Type | Individual |
| Full Name | BRIAN J LOGUE |
| Credential | MD |
| Practice Address |
2907 S Mcintire Dr Bloomington IN 47403-4224 |
| Mailing Address |
2907 Mcintyre Dr Bloomington IN 47403-4209 |
| Practice Telephone | 8123328765 |
| Practice Fax Number | 8123363425 |
| Mailing Telephone | 8123328765 |
| Mailing Fax Number | 8123363425 |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2017-12-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 208800000X | Urology | 01037620A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | 100167090 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649345786 | Brian Wayne Logue | Pharmacist | 101 N University St, Isu Health Service Pharmacy, Normal, IL 61790-2540 | 2006-11-22 |
| 1134731631 | Brian Logue | Pharmacist | 4926 Cane Run Rd, Louisville, KY 40216-1149 | 2020-08-18 |
| 1730234212 | Brian Logue | Pharmacist | 45 Pine St, 1st Medical Group, Langley Afb, VA 23665-2025 | 2007-01-24 |
| Street Address |
2907 S MCINTIRE DR |
| City | BLOOMINGTON |
| State | IN |
| Zip Code | 47403-4224 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275015901 | Jennifer Keith | Physician Assistant | 2907 S Mcintire Dr, Bloomington, IN 47403-4225 | 2018-08-29 |
| 1578561700 | Eric M Smith | Urology | 2907 S Mcintire Dr, Bloomington, IN 47403-4224 | 2005-07-12 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043783673 | Brook Whitaker | Registered Nurse | 4011 S. Monroe Medical Park Blvd, Bloomington, IN 47403 | 2019-01-07 |
| 1598251175 | Jacob Edward Lundorf | Nurse Practitioner | 2100 S Liberty Dr Ste B, Bloomington, IN 47403 | 2018-07-06 |
| 1568973717 | Gregory Thomas Dougan | Physician Assistant | 418 South Landmark Avenue, Bloomington, IN 47403 | 2017-10-16 |
| 1295276160 | Indiana Center for Recovery, LLC | Substance Abuse Rehabilitation Facility | 1004 W 1st Street, Bloomington, IN 47403 | 2017-03-13 |
| 1144694217 | Kayla Dewolf | Specialist/Technologist | 1471 W Allen St, Bloomington, IN 47403 | 2015-11-30 |
| 1164806444 | Monroe Hosoital | General Acute Care Hospital | 4011 Monroe Medical Park, Bloomington, IN 47403 | 2015-07-16 |
| 1821411588 | Jennifer Turner | Occupational Therapy Assistant | 1023 West Main St, Swiss Villa, Vevay, IN 47403 | 2014-01-30 |
| 1104170232 | Kendall Basore | Social Worker | 445 S. Landmark Ave., Bloomington, IN 47403 | 2012-10-26 |
| 1568715886 | Indiana Hearing LLC | Hearing Aid Equipment | 2019 S Liberty Dr, Bloomington, IN 47403 | 2012-10-24 |
| 1679870232 | Accurate Hearing Services | Clinic/Center | 1355 W Second St, #3, Bloomington, IN 47403 | 2011-02-17 |
| Find all providers in zip 47403 | ||||
| Taxonomy Code | 208800000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Urology |
| A urologist manages benign and malignant medical and surgical disorders of the genitourinary system and the adrenal gland. This specialist has comprehensive knowledge of and skills in endoscopic, percutaneous and open surgery of congenital and acquired conditions of the urinary and reproductive systems and their contiguous structures. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Urology, 2007. http://www.abu.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Urology. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1427357227 | Premier Medical Group, LLC | Urology | 1401 Eastland Dr Ste B, Bloomington, IL 61701-3514 | 2011-03-18 |
| 1710112271 | Michael Andrew Surian | Urology | 880 Woodcrest Drive, Bloomington, IN 47401 | 2009-05-27 |
| 1083608335 | Timothy A Habbe | Urology | 2907 Mcintyre Dr, Bloomington, IN 47403-4209 | 2005-09-01 |
| 1659379535 | Warren L Gray | Urology | 2907 Mcintyre Dr., Bloomington, IN 47403-4224 | 2005-07-13 |
| 1578940151 | Ashley Shumate | Urology | 1520 S Liberty Dr, Bloomington, IN 47403-5167 | 2015-05-02 |
| 1790075596 | Amanda Jean Pettibone-pond | Urology | 1520 S Liberty Dr, Bloomington, IN 47403-5167 | 2011-04-13 |
| 1548427123 | Paula J Bunde | Urology | 1520 S Liberty Dr, Bloomington, IN 47403-5167 | 2008-05-21 |
| 1831215391 | Urologic Surgery Associates, S.c. | Urology | 1414 Woodbine Rd, Bloomington, IL 61704-2817 | 2007-03-22 |
| 1003912726 | Dean L Lenz | Urology | 1520 S Liberty Dr, Bloomington, IN 47403-5167 | 2006-09-16 |
| 1972522720 | Daniel Lange | Urology | 1701 E College Ave, Bloomington, IL 61704-2101 | 2006-07-19 |
| Find all providers in BLOOMINGTON | ||||
| City | BLOOMINGTON |
| Zip Code | 47403 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.