Healthcare Provider Details

I. General information

NPI: 1174508618
Provider Name (Legal Business Name): TONY R LOGGINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 W ELM AVE
LINTON ND
58552-2100
US

IV. Provider business mailing address

PO BOX 850
LINTON ND
58552-0850
US

V. Phone/Fax

Practice location:
  • Phone: 701-254-4531
  • Fax: 701-254-5459
Mailing address:
  • Phone: 701-254-4531
  • Fax: 701-254-5459

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number20374
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH2541
License Number StateTX
# 3
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number7464
License Number StateSD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: