Provider Demographics
NPI:1356655104
Name:FRANK, LOGAN A (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:A
Last Name:FRANK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 3242
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-3242
Mailing Address - Country:US
Mailing Address - Phone:317-705-6708
Mailing Address - Fax:
Practice Address - Street 1:1316 OLD HIGHWAY 63 S
Practice Address - Street 2:STE 102
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6092
Practice Address - Country:US
Practice Address - Phone:573-443-4591
Practice Address - Fax:573-874-1369
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO20130319342085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2013031934OtherMD LICENSE