Basic Information
| Provider Information | |||||||||
| NPI: | 1225265721 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LOGAN | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | SCOTT | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 530 N MONTE VISTA ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204675 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804367101 | ||||||||
| FaxNumber: | 5804364447 | ||||||||
| Practice Location | |||||||||
| Address1: | 430 N MONTE VISTA ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204610 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5802721731 | ||||||||
| FaxNumber: | 5802721720 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2009 | ||||||||
| LastUpdateDate: | 01/07/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2083A0100X | G2179 | TX | N | Allopathic & Osteopathic Physicians | Preventive Medicine | Aerospace Medicine | 2083P0011X | 12427 | OK | Y | Allopathic & Osteopathic Physicians | Preventive Medicine | Undersea and Hyperbaric Medicine | 208600000X | 12427 | OK | N | Allopathic & Osteopathic Physicians | Surgery |
No ID Information.