Individual
LOGAN CLAY FREDERICKSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
3705 MIDWAY DR, BAKER CITY, OR 97814-1456
(541) 519-4250
(541) 239-5259
Mailing address
3705 MIDWAY DR, BAKER CITY, OR 97814-1456
(541) 519-4250
(541) 239-5259
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
DO176820
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO176820
MEDICAL LICENSE
OR
Enumeration date
06/24/2013
Last updated
02/01/2024
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