Individual
THOMAS BROOKS LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
800 N ELM ST, HENDERSON, KY 42420-2709
(812) 499-9948
Mailing address
1020 PROFESSIONAL BOULEVARD, EVANSVILLE, IN 47714-8009
(812) 473-2060
(812) 473-0763
Taxonomy
Speciality
Code
Description
License number
State
207Y00000X
Otolaryngology Physician
01029120A
IN
207Y00000X
Otolaryngology Physician
Primary
14807
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000181609
ANTHEM
IN
01
—
000000181609
ANTHEM
KY
01
—
064946
HEALTH ALLIANCE
IN
05
—
100246610A
—
IN
01
—
110013
HEALTHLINK
IN
05
—
64148075
—
KY
Enumeration date
10/13/2005
Last updated
05/20/2020
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