Provider Demographics
NPI:1073711891
Name:LOGAN, MARCUS TREVANT SR (CRNA)
Entity Type:Individual
Prefix:MR
First Name:MARCUS
Middle Name:TREVANT
Last Name:LOGAN
Suffix:SR
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 104
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75070-1658
Mailing Address - Country:US
Mailing Address - Phone:214-592-8159
Mailing Address - Fax:949-561-5834
Practice Address - Street 1:8751 COLLIN MCKINNEY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75070-1658
Practice Address - Country:US
Practice Address - Phone:214-592-8159
Practice Address - Fax:949-561-5834
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN12794367500000X
KY3007916367500000X
TXAP123969367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX209208202Medicaid
TX8245UHOtherBCBS TX
TX348031YK6UMedicare PIN