MEDICARE: SUSAN LEE LOGAN MD

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	2086X0206X	Surgical Oncology Physician	A81958	CA
2	208600000X	Surgery Physician	A81958	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	00A819580	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1831372242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN LEE LOGAN MD

Provider Business Mailing Address
First Line	:	7417 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3637
Country	:	US
Telephone Number	:	559-500-4502
Fax Number	:	559-573-8749

Provider Business Practice Location Address
First Line	:	7417 N CEDAR AVE
Second Line	:
City	:	FRESNO
State	:	CA
Zip	:	93720-3637
Country	:	US
Telephone Number	:	559-500-4502
Fax Number	:	559-573-8749

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

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	12/09/2025

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