Individual
LOGAN BOATMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6550 FANNIN ST, SUITE 749, HOUSTON, TX 77030-2717
(713) 441-7465
Mailing address
6550 FANNIN ST, SUITE 749, HOUSTON, TX 77030-2717
(713) 441-7465
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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