Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Logan Robert Vidal, DO

Individual provider Family Medicine Physician · NPI 1306133210

Logan Robert Vidal, DO is a Family Practice in San Diego, California. Qualified in 2011, 15 years ago. Practices with Broadlawns Medical Center, a 306-clinician group and accepts Medicare assignment. Licensed in Florida and Iowa.

Years since qualifying
15
Licensed in
FL, IA
In the registry since
2011
Specialties on file
3
What do these letters mean?
DO — Doctor of Osteopathic Medicine
A fully licensed physician, trained like an MD with additional musculoskeletal training. Equivalent practice rights in all 50 states.

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Practice location Address checks out

Vamc 3350 La Jolla Village Dr
San Diego, CA 92161-0001
Phone: (858) 552-8585
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence OS12575 (FL)
Family Medicine Physician Taxonomy 207Q00000X · Licence R-9308 (IA)
Family Medicine Physician Taxonomy 207Q00000X · Licence 4347 (IA)

Record details

NPI number1306133210
Entity typeIndividual (Type 1)
GenderMale
Credentials DO
Sole proprietorYes
NPI enumeratedJune 30, 2011
Last updated in NPPESDecember 17, 2019
Certification dateDecember 17, 2019

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2011 (15 years in practice)
Group practice Broadlawns Medical Center — 306 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount

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