Individual
DR. JOHN RYAN LOGAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2101 HIGHWAY 90, GAUTIER, MS 39553-5340
(228) 809-5510
(228) 809-5519
Mailing address
1812 SHELBY LN, OCEAN SPRINGS, MS 39564-5055
(601) 624-8229
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
21375
MS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
21375
MS STATE BOARD OF MEDICAL LICENSURE
MS
Enumeration date
07/06/2008
Last updated
09/19/2019
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