MEDICARE: LOGAN ALLEN FROST PA-C

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	14242594-1206	UT

General Provider Information

NPI Number	:	1821871450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LOGAN ALLEN FROST PA-C

Provider Business Mailing Address
First Line	:	945 CHAMBERS ST STE 3
Second Line	:
City	:	OGDEN
State	:	UT
Zip	:	84403-4583
Country	:	US
Telephone Number	:	801-627-2122
Fax Number	:	801-627-2125

Provider Business Practice Location Address
First Line	:	945 CHAMBERS ST STE 3
Second Line	:
City	:	SOUTH OGDEN
State	:	UT
Zip	:	84403-4583
Country	:	US
Telephone Number	:	801-627-2122
Fax Number	:	801-627-2125

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

Provider Enumeration Date	:	08/16/2023
Last Update Date	:	01/19/2026

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