Healthcare Provider Details

I. General information

NPI: 1568040533
Provider Name (Legal Business Name): TREVOR THOMAS LOGAN MD, PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3366 NW EXPRESSWAY STE 200
OKLAHOMA CITY OK
73112-4416
US

IV. Provider business mailing address

3366 NW EXPRESSWAY STE 200
OKLAHOMA CITY OK
73112-4416
US

V. Phone/Fax

Practice location:
  • Phone: 405-713-9930
  • Fax: 405-713-9931
Mailing address:
  • Phone: 405-713-9930
  • Fax: 405-713-9931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number47854
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: