Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | ||
N | 222Z00000X | Podiatrist | ||
Y | 224P00000X | Prosthetist |
NPI | 1326316951 |
---|---|
Provider Name | Mr. Patrick Vincent Logan |
First Address | Springfield, PA 19064-1926 |
Second Address | Springfield, PA 19064-1926 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/12/2011 |
Last Update Date | 10/12/2011 |