Healthcare Provider Details

I. General information

NPI: 1679659239
Provider Name (Legal Business Name): BOBBY ROYCE LOGAN RRT-NPS/RPSGT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2006
Last Update Date: 11/16/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3602 86TH ST
LUBBOCK TX
79423-2647
US

IV. Provider business mailing address

3602 86TH ST
LUBBOCK TX
79423-2647
US

V. Phone/Fax

Practice location:
  • Phone: 806-470-9420
  • Fax: 806-745-5171
Mailing address:
  • Phone: 806-470-9420
  • Fax: 806-745-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number57224
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code2279P3900X
TaxonomyNeonatal/Pediatric Registered Respiratory Therapist
License Number2463
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: