Individual
JASON A. LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
7600 S LEWIS AVE, TULSA, OK 74136-6836
(731) 228-9778
(918) 493-7813
Mailing address
210 JAMES RD, BOLIVAR, TN 38008-1110
(731) 658-5421
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
22922
OK
207Q00000X
Family Medicine Physician
Primary
22922
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200018630A
—
OK
Enumeration date
10/24/2005
Last updated
01/30/2010
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