MEDICARE: DR. JOHN LANDISS LOGAN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208800000X	Urology Physician	32200	CO

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	340012614	OTHER	CO	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1124020771
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN LANDISS LOGAN MD

Provider Business Mailing Address
First Line	:	2005 E 18TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1109
Country	:	US
Telephone Number	:	303-321-4212
Fax Number	:	303-388-2459

Provider Business Practice Location Address
First Line	:	2005 E 18TH AVE
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80206-1109
Country	:	US
Telephone Number	:	303-321-4212
Fax Number	:	303-388-2459

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	06/24/2010

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