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General NPI Number Information
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NPI Number | 1992704290
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Entity Type | Individual
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Provider Name | PATRICK CLIFFORD LOGAN MD
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Gender | Male
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Dates
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Enumeration Date | 07/19/2005
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Last Update Date | 10/09/2013
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Provider Practice Location Address
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Address Line | 1910 N ARLINGTON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-5128
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Country | US
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Telephone | 317-359-5358
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Fax | 317-359-5358
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Provider Business Mailing Address
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Address Line | 1910 N ARLINGTON AVE
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City | INDIANAPOLIS
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State | IN
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Zip | 46218-5199
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Country | US
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Telephone | 317-359-5358
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Fax | 317-359-5358
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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 | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 01020481A
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License Number State | IN
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