Individual
MARK J LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
3841 PIPER ST, SUITE T300, ANCHORAGE, AK 99508-4624
(907) 563-3103
(907) 561-1862
Mailing address
3841 PIPER ST, SUITE T300, ANCHORAGE, AK 99508-4624
(907) 563-3103
(907) 561-1862
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
965
AK
363A00000X
Physician Assistant
PA05197
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1039349
—
LA
05
—
MDA0383
—
AK
Enumeration date
03/02/2007
Last updated
06/21/2011
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