Individual
DR. LOGAN J. BANKS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
1423 N. JEFFERSON, #B100, SPRINGFIELD, MO 65802-1917
(417) 269-8817
(417) 269-8744
Mailing address
PO BOX 4046, SPRINGFIELD, MO 65808-4046
(417) 269-5712
(417) 269-7567
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2007018070
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200609930A
—
KS
Enumeration date
07/10/2007
Last updated
02/21/2020
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