Provider Demographics
NPI:1083674147
Name:HULL, LOGAN BEN II (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:BEN
Last Name:HULL
Suffix:II
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:2011 BARBOA CIR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-3430
Mailing Address - Country:US
Mailing Address - Phone:907-929-3829
Mailing Address - Fax:907-929-3873
Practice Address - Street 1:2925 DEBARR RD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-2983
Practice Address - Country:US
Practice Address - Phone:907-257-4844
Practice Address - Fax:907-257-4905
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS15-00273363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical