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General NPI Number Information
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NPI Number | 1588603682
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Entity Type | Individual
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Provider Name | WILLIAM C LOGAN JR. M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/05/2006
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 724 N MAIN ST
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City | LACONIA
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State | NH
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Zip | 03246-2742
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Country | US
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Telephone | 603-524-9201
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Fax |
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Provider Business Mailing Address
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Address Line | 250 PLEASANT ST
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City | CONCORD
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State | NH
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Zip | 03301-7559
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Country | US
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Telephone | 603-227-7000
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Fax | 864-327-1662
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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 | 207RG0300X
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Taxonomy Name | Geriatric Medicine (Internal Medicine) Physician
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License Number | 23138
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License Number State | SC
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