Individual
MR. LOGAN MCHAEL SOUTHWELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1601 GORDON COOPER DR, SHAWNEE, OK 74801-9002
(405) 878-3854
(405) 273-1752
Mailing address
1601 GORDON COOPER DR, SHAWNEE, OK 74801-9002
(405) 878-3854
(405) 273-1752
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
04/19/2024
Last updated
04/19/2024
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