Individual
DR. JONATHAN ROY LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1325 LOCUST AVE, FAIRMONT, WV 26554-1435
(304) 367-7100
Mailing address
6005 WOOLAND BLUFFS DRIVE, MORGANTOWN, WV 26508
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
0101243177
VA
207P00000X
Emergency Medicine Physician
20682
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1000450-000
—
WV
Enumeration date
06/08/2006
Last updated
11/17/2021
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