Provider Demographics
NPI:1346923711
Name:JUGLER, LOGAN PIERCE
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:PIERCE
Last Name:JUGLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2409 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-3207
Mailing Address - Country:US
Mailing Address - Phone:424-400-7722
Mailing Address - Fax:424-400-7721
Practice Address - Street 1:981 E TUOLUMNE RD STE 104
Practice Address - Street 2:
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95382-1544
Practice Address - Country:US
Practice Address - Phone:209-454-0494
Practice Address - Fax:209-454-0504
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-10
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant