Provider Demographics
NPI:1164520714
Name:LOGAN, DWAYNE KEITH (MD)
Entity type:Individual
Prefix:DR
First Name:DWAYNE
Middle Name:KEITH
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:14726 RAMONA AVE STE 203
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5730
Mailing Address - Country:US
Mailing Address - Phone:626-305-9100
Mailing Address - Fax:626-305-0152
Practice Address - Street 1:5991 E SPRING ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90808-3752
Practice Address - Country:US
Practice Address - Phone:562-938-9945
Practice Address - Fax:562-496-0433
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2024-06-13
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG68583207WX0009X, 207WX0120X, 207WX0200X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
No207WX0120XAllopathic & Osteopathic PhysiciansOphthalmologyCornea and External Diseases Specialist
No207WX0200XAllopathic & Osteopathic PhysiciansOphthalmologyOphthalmic Plastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWG68583OMedicare PIN
CAF92469Medicare UPIN
WG68583DMedicare PIN