MEDICARE: MR. CARY PHILLIP LOGAN M.D.

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	207R00000X	Internal Medicine Physician	7068	NV

General Provider Information

NPI Number	:	1699078865
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARY PHILLIP LOGAN M.D.

Provider Business Mailing Address
First Line	:	PO BOX 15204
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89114-5204
Country	:	US
Telephone Number	:	702-677-2644
Fax Number	:	702-796-0856

Provider Business Practice Location Address
First Line	:	350 E DESERT INN RD UNIT G103
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89109-9007
Country	:	US
Telephone Number	:	702-677-2644
Fax Number	:	702-796-0856

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

Provider Enumeration Date	:	12/09/2010
Last Update Date	:	12/09/2010

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