Individual
BENTON C LOGGAINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
P.A.-C
Contact information
Practice address
3501 W E KNIGHT DRIVE, FORT SMITH, AR 72903
(479) 709-6700
(479) 709-6751
Mailing address
PO BOX 11230, FORT SMITH, AR 72917-1230
(479) 709-7000
(479) 709-7051
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA276
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
200022460A
OKLAHOMA MEDICAID
AR
Enumeration date
03/10/2006
Last updated
12/14/2009
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