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Individual

LOGAN ANDERSON

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
DO

Contact information

Practice address
132 5TH AVE W STE 1&2, JEROME, ID 83338-1871
(208) 814-9800
Mailing address
132 5TH AVE W STE 1&2, JEROME, ID 83338-1871
(208) 814-9800

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
O-1750
ID

Other

Enumeration date
05/24/2021
Last updated
06/25/2024
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