Healthcare Provider Details

I. General information

NPI: 1659585289
Provider Name (Legal Business Name): DOUGLAS K. LOGAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7826 COOPER RD
CINCINNATI OH
45242-7619
US

IV. Provider business mailing address

764 SAINT THOMAS CT
CINCINNATI OH
45230-3872
US

V. Phone/Fax

Practice location:
  • Phone: 513-984-1000
  • Fax: 513-985-2182
Mailing address:
  • Phone: 513-231-7229
  • Fax: 513-579-0444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number43241
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: