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NPI Code Detail

MEDICARE: LOGAN RICHARDS MD

MEDICARE: LOGAN RICHARDS 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
12085R0202XDiagnostic Radiology PhysicianMED-PHYS-LIC-173116MT
2390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1871171165
Entity Type Code : Individual
Provider Name (Legal Business Name) : LOGAN RICHARDS MD
Provider Business Mailing Address
First Line : 1648 ELLIS ST STE 201
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-8811
Country : US
Telephone Number : 406-587-8631
Fax Number : 406-587-1343
Provider Business Practice Location Address
First Line : 1648 ELLIS ST STE 201
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-8811
Country : US
Telephone Number : 406-587-8631
Fax Number : 406-587-1343
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/30/2021
Last Update Date : 05/28/2026

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Directions to “ LOGAN RICHARDS MD” Practice Location

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