Individual
LOGAN ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
930 SW ABBEY ST, NEWPORT, OR 97365-4820
(541) 265-2244
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO219980
OR
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/21/2021
Last updated
10/28/2024
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