Individual
LOGAN BOYER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1190 N STATE ST STE 502, JACKSON, MS 39202-2414
(601) 944-1781
Mailing address
101 BRIARS DR APT 703, CLINTON, MS 39056-6119
(570) 765-8697
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA00787
MS
363AS0400X
Surgical Physician Assistant
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Other
Enumeration date
02/02/2024
Last updated
08/21/2024
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