Healthcare Provider Details

I. General information

NPI: 1356655104
Provider Name (Legal Business Name): LOGAN A FRANK M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 09/14/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 OLD HIGHWAY 63 S STE 102
COLUMBIA MO
65201-6092
US

IV. Provider business mailing address

PO BOX 3242
INDIANAPOLIS IN
46206-3242
US

V. Phone/Fax

Practice location:
  • Phone: 573-443-4591
  • Fax: 573-874-1369
Mailing address:
  • Phone: 317-705-6708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number2013031934
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: