Individual
DR. JOHN LANDISS LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2005 E 18TH AVE, DENVER, CO 80206-1109
(303) 321-4212
(303) 388-2459
Mailing address
2005 E 18TH AVE, DENVER, CO 80206-1109
(303) 321-4212
(303) 388-2459
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
32200
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01322007
—
CO
01
—
340012614
RAILROAD MEDICARE
CO
Enumeration date
08/12/2005
Last updated
06/24/2010
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