# LOGAN UROLOGY CLINIC

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** LOGAN UROLOGY CLINIC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1326274507
- **Legal business name:** LOGAN UROLOGY CLINIC
- **Authorized official:** DR. RYAN HAROLD LARSEN M.D. (PHYSICIAN)
- **Authorized official phone:** (435) 753-1171

## Contact information

- **Practice address:** 550 E 1400 N, STE J, LOGAN, UT 84341-2406
- **Practice address phone:** (435) 753-1171
- **Practice address fax:** (435) 792-4464
- **Mailing address:** 550 E 1400 N, STE J, LOGAN, UT 84341-2406
- **Mailing address phone:** (435) 753-1171
- **Mailing address fax:** (435) 792-4464

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302F00000X | Exclusive Provider Organization | 175141-1205 | UT | Yes |

## Other

- **Enumeration date:** 06/02/2009
- **Last updated:** 06/02/2009

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 08582 | — | UT |
| 05 | — | 340017516 | — | ID |