Individual
LOGAN BOATMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
P6784
TX
390200000X
Student in an Organized Health Care Education/Training Program
BP1-0031304
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
346620301
—
TX
05
—
346620302
—
TX
01
—
8EU503
BLUE CROSS BLUE SHIELD
TX
Enumeration date
06/03/2008
Last updated
09/28/2015
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