Healthcare Provider Details

I. General information

NPI: 1831372242
Provider Name (Legal Business Name): SUSAN LEE LOGAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2007
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7417 N CEDAR AVE
FRESNO CA
93720-3637
US

IV. Provider business mailing address

7417 N CEDAR AVE
FRESNO CA
93720-3637
US

V. Phone/Fax

Practice location:
  • Phone: 559-500-4502
  • Fax: 559-573-8749
Mailing address:
  • Phone: 559-500-4502
  • Fax: 559-573-8749

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberA81958
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA81958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: