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General NPI Number Information
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NPI Number | 1831620327
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Entity Type | Individual
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Provider Name | LOGAN JON DANIELSON DO
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Gender | Male
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Dates
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Enumeration Date | 03/25/2017
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 1330 N WASHINGTON ST STE 1080
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City | SPOKANE
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State | WA
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Zip | 99201-2446
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Country | US
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Telephone | 509-824-7327
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Fax |
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Provider Business Mailing Address
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Address Line | 2426 W CENTENNIAL PL
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City | SPOKANE
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State | WA
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Zip | 99201-3135
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Country | US
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Telephone | 208-249-2678
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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 | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 3961866
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | OP61566334
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 207QS0010X
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Taxonomy Name | Sports Medicine (Family Medicine) Physician
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License Number | 20A20017
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License Number State | CA
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