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General NPI Number Information
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NPI Number | 1346923711
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Entity Type | Individual
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Provider Name | LOGAN PIERCE JUGLER
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Gender | Male
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Dates
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Enumeration Date | 08/10/2023
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Last Update Date | 08/10/2023
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Provider Practice Location Address
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Address Line | 981 E TUOLUMNE RD STE 104
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City | TURLOCK
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State | CA
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Zip | 95382-1544
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Country | US
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Telephone | 209-454-0494
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Fax | 209-454-0504
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Provider Business Mailing Address
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Address Line | 2409 ARTESIA BLVD
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City | REDONDO BEACH
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State | CA
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Zip | 90278-3207
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Country | US
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Telephone | 424-400-7722
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Fax | 424-400-7721
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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