P C Logan MD Inc

Primary specialty

Dermatology PhysicianTaxonomy code 207N00000X

License

01020481A Issued in IN

Legal business name

P C LOGAN MD INC

Practice address

1910 N Arlington Ave
Indianapolis, IN 46218-5128

Phone

(317) 359-5357

Fax

(317) 359-5358

NPI assigned

Jul 24, 2007

Last updated

Jul 24, 2007By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Patrick Clifford Logan, MDNPI 1992704290

Title

President/Owner

Phone

(317) 359-5357

Specialties & licenses 1

Addresses

Other identifiers 3

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Patrick Clifford Logan, MD

  • Dermatology Physician
  • Indianapolis, IN
  • NPI 1992704290
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1185235200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1185235200000",
    "number": "1831399278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1910 N ARLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185128",
            "telephone_number": "317-359-5357",
            "fax_number": "317-359-5358"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1910 N ARLINGTON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462185128",
            "telephone_number": "317-359-5357",
            "fax_number": "317-359-5358"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "P C LOGAN MD INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-07-24",
        "last_updated": "2007-07-24",
        "status": "A",
        "authorized_official_last_name": "LOGAN",
        "authorized_official_first_name": "PATRICK",
        "authorized_official_middle_name": "CLIFFORD",
        "authorized_official_title_or_position": "PRESIDENT/OWNER",
        "authorized_official_telephone_number": "317-359-5357",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "IN",
            "license": "01020481A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100055560A",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE",
            "identifier": "072068448",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM BLUE CROSS & BLUE",
            "identifier": "000000082565",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Dermatology Physician in Indianapolis, IN
• Providers in Indianapolis, IN by specialty
• Dermatology Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.