MEDICARE: LOGAN JAMES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	1185084	MA
2	363AM0700X	Medical Physician Assistant	1185084	CO
3	363A00000X	Physician Assistant	1185084	CO

General Provider Information

NPI Number	:	1376217273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN JAMES

Provider Business Mailing Address
First Line	:	5607 BARNES RD STE 140
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1347
Country	:	US
Telephone Number	:	197-763-8507
Fax Number	:

Provider Business Practice Location Address
First Line	:	5607 BARNES RD STE 140
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80917-1347
Country	:	US
Telephone Number	:	719-776-3850
Fax Number	:	719-776-3855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/04/2021
Last Update Date	:	02/07/2025

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Directions to “ LOGAN JAMES ” Practice Location

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