Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156F00000X | Technician/Technologist |
NPI | 1124506571 |
---|---|
Provider Name | Logan Tanner Cox |
First Address | Durango, CO 81301-7940 |
Second Address | Durango, CO 81301-7940 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/07/2018 |
Last Update Date | 29/07/2018 |