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Organization
LOGAN UROLOGY CLINIC
Active
Organization
LOGAN UROLOGY CLINIC
Active
Parent organization
LOGAN UROLOGY CLINIC
Organization subpart
Yes
Provider details
NPI number
Legal business name
LOGAN UROLOGY CLINIC
Authorized official
DR. RYAN HAROLD LARSEN M.D. (PHYSICIAN)
(435) 753-1171
Entity
Organization
Contact information
Practice address
550 E 1400 N, STE J, LOGAN, UT 84341-2406
(435) 753-1171
(435) 792-4464
Mailing address
550 E 1400 N, STE J, LOGAN, UT 84341-2406
(435) 753-1171
(435) 792-4464
Taxonomy
Speciality
Code
Description
License number
State
302F00000X
Exclusive Provider Organization
Primary
175141-1205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
08582
—
UT
05
—
340017516
—
ID
Enumeration date
06/02/2009
Last updated
06/02/2009
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