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General NPI Number Information
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NPI Number | 1710540885
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Entity Type | Individual
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Provider Name | LOGAN REED JONES DO
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Gender | Male
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Dates
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Enumeration Date | 04/15/2019
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Last Update Date | 08/30/2022
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Provider Practice Location Address
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Address Line | 491 HERITAGE DR
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City | JEROME
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State | ID
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Zip | 83338-6701
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Country | US
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Telephone | 208-644-7507
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Fax | 208-644-7501
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Provider Business Mailing Address
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Address Line | 863 SUN PEAK WAY
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City | TWIN FALLS
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State | ID
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Zip | 83301-8977
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Country | US
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Telephone | 208-589-6588
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | O-1489
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License Number State | ID
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