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General NPI Number Information
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NPI Number | 1356655104
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Entity Type | Individual
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Provider Name | LOGAN A FRANK M.D.
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Gender | Male
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Dates
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Enumeration Date | 08/04/2010
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Last Update Date | 09/14/2022
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Provider Practice Location Address
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Address Line | 1316 OLD HIGHWAY 63 S STE 102
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City | COLUMBIA
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State | MO
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Zip | 65201-6092
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Country | US
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Telephone | 573-443-4591
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Fax | 573-874-1369
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Provider Business Mailing Address
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Address Line | PO BOX 3242
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3242
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Country | US
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Telephone | 317-705-6708
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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 | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 2013031934
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License Number State | MO
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