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General NPI Number Information
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NPI Number | 1346897303
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Entity Type | Individual
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Provider Name | LOGAN DRAKE HIRSCH DNP, CRNA
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Gender | Male
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Dates
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Enumeration Date | 08/23/2019
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Last Update Date | 06/15/2023
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Provider Practice Location Address
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Address Line | 1650 COCHRANE CIR UNIT MEDDAC
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City | FORT CARSON
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State | CO
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Zip | 80913-4604
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Country | US
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Telephone | 417-850-1993
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Fax |
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Provider Business Mailing Address
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Address Line | 641 GLEN EYRIE CIR
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City | COLORADO SPRINGS
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State | CO
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Zip | 80904-2138
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Country | US
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Telephone | 417-850-1993
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | R101414
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License Number State | AR
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Taxonomy #2
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 216892
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License Number State | AR
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | C-APN.0003798-C-CRNA
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License Number State | CO
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