Provider Demographics
NPI:1003579889
Name:HOWARD, LOGAN BODE (PA)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:BODE
Last Name:HOWARD
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10635 PROFESSIONAL CIR STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89521-5836
Mailing Address - Country:US
Mailing Address - Phone:775-852-0505
Mailing Address - Fax:775-852-0508
Practice Address - Street 1:10635 PROFESSIONAL CIR STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89521-5836
Practice Address - Country:US
Practice Address - Phone:775-852-0505
Practice Address - Fax:775-852-0508
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-18
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2728363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant