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NPI Code Detail

MEDICARE: ISAIAH LOGAN MD

MEDICARE: ISAIAH 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
1207Q00000XFamily Medicine PhysicianBP10054656TX

General Provider Information

NPI Number : 1215318696
Entity Type Code : Individual
Provider Name (Legal Business Name) : ISAIAH LOGAN MD
Provider Business Mailing Address
First Line : 1600 PROVIDENCE DR
Second Line : ATTN: TRACI MITCHELL - ADMN
City : WACO
State : TX
Zip : 76707-2261
Country : US
Telephone Number : 254-313-4200
Fax Number : 254-313-4326
Provider Business Practice Location Address
First Line : 709 BARTON ST
Second Line :
City : HEARNE
State : TX
Zip : 77859-3009
Country : US
Telephone Number : 979-279-3451
Fax Number : 979-595-1704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2015
Last Update Date : 09/12/2024

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