Individual
DR. LOGAN B LACKEY II
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2055 S FREMONT AVE, SUITE 120, SPRINGFIELD, MO 65804-2206
(417) 820-2500
Mailing address
2055 S FREMONT AVE, SUITE 120, SPRINGFIELD, MO 65804-2206
(417) 820-2500
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
2016020760
MO
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
04/20/2010
Last updated
07/05/2016
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