Provider Demographics
NPI:1689675175
Name:LOGAN, JAMES W (MD)
Entity type:Individual
Prefix:DR
First Name:JAMES
Middle Name:W
Last Name:LOGAN
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Gender:M
Credentials:MD
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Mailing Address - Street 1:148 HIGHWAY 105 EXT
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5681
Mailing Address - Country:US
Mailing Address - Phone:828-386-2746
Mailing Address - Fax:828-386-2750
Practice Address - Street 1:148 HIGHWAY 105 EXT
Practice Address - Street 2:SUITE 104
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5681
Practice Address - Country:US
Practice Address - Phone:828-386-2746
Practice Address - Fax:828-386-2750
Is Sole Proprietor?:No
Enumeration Date:2005-08-09
Last Update Date:2016-08-04
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Provider Licenses
StateLicense IDTaxonomies
NC2013-01084207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
F64631Medicare UPIN
F64631Medicare UPIN
AR124246001Medicaid