Healthcare Provider Details

I. General information

NPI: 1649195223
Provider Name (Legal Business Name): MR. DONALD RAY LOGSDON JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2026
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32018 HIGHWAY 59
MAUD OK
74854-4402
US

IV. Provider business mailing address

1184 N OLD HIGHWAY 69
EUFAULA OK
74432-5637
US

V. Phone/Fax

Practice location:
  • Phone: 405-374-1225
  • Fax:
Mailing address:
  • Phone: 918-618-7891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: