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NPI Code Detail

MEDICARE: DR. LOGAN REX TAYSOM MD, MS

MEDICARE: DR. LOGAN REX TAYSOM MD, MS
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
1207L00000XAnesthesiology Physician79111AZ

General Provider Information

NPI Number : 1780324038
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LOGAN REX TAYSOM MD, MS
Provider Business Mailing Address
First Line : 4025 W BORAS MINE CT
Second Line :
City : TUCSON
State : AZ
Zip : 85745-4196
Country : US
Telephone Number : 480-254-8690
Fax Number :
Provider Business Practice Location Address
First Line : 1625 N CAMPBELL AVE
Second Line :
City : TUCSON
State : AZ
Zip : 85719-4330
Country : US
Telephone Number : 520-694-0111
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2022
Last Update Date : 06/01/2026

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