Individual
LOGAN ROLES
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1102 W MACARTHUR ST, SHAWNEE, OK 74804-1743
(405) 273-2270
Mailing address
1102 W MACARTHUR ST, SHAWNEE, OK 74804-1743
(405) 273-2270
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5576
OK
Other
Enumeration date
03/10/2025
Last updated
07/30/2025
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