Healthcare Provider Details

I. General information

NPI: 1033524582
Provider Name (Legal Business Name): LOGAN MCGUFFEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/24/2014
Last Update Date: 01/06/2022
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

IV. Provider business mailing address

5500 PINE LAKE RD
LINCOLN NE
68516-3389
US

V. Phone/Fax

Practice location:
  • Phone: 402-489-8888
  • Fax: 402-421-1945
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2014018335
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License Number31523
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: