Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | CH00001025 | WA |
NPI | 1447704655 |
---|---|
Provider Name | Dr. John Robert Logan |
First Address | Kirkland, WA 98034-3557 |
Second Address | Kirkland, WA 98034-3557 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/08/2016 |
Last Update Date | 05/08/2016 |