Provider Demographics
NPI:1164572186
Name:LOGAN, IAN J (MD)
Entity Type:Individual
Prefix:DR
First Name:IAN
Middle Name:J
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:10470 OLD PLACERVILLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95827-2539
Mailing Address - Country:US
Mailing Address - Phone:800-470-0071
Mailing Address - Fax:
Practice Address - Street 1:2068 JOHN JONES ROAD
Practice Address - Street 2:SUITE # 3116
Practice Address - City:DAVIS
Practice Address - State:CA
Practice Address - Zip Code:95616-9711
Practice Address - Country:US
Practice Address - Phone:530-747-0389
Practice Address - Fax:530-747-0623
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2015-07-29
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Provider Licenses
StateLicense IDTaxonomies
CAA97807207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology