Healthcare Provider Details

I. General information

NPI: 1972184562
Provider Name (Legal Business Name): LOGAN WADE BEST DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2021
Last Update Date: 07/31/2024
Certification Date: 07/31/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 WINDOVER RD
JONESBORO AR
72401-6159
US

IV. Provider business mailing address

PO BOX 1960
JONESBORO AR
72403-1960
US

V. Phone/Fax

Practice location:
  • Phone: 870-936-8000
  • Fax: 870-934-3653
Mailing address:
  • Phone: 870-936-8000
  • Fax: 870-934-3652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberE-15751
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: