Provider Demographics
NPI:1407416472
Name:ORR, LOGAN (DPM)
Entity Type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:ORR
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:645 W 5TH ST
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3172
Mailing Address - Country:US
Mailing Address - Phone:812-634-2778
Mailing Address - Fax:
Practice Address - Street 1:645 W 5TH ST
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-3172
Practice Address - Country:US
Practice Address - Phone:812-634-2778
Practice Address - Fax:812-634-2909
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN41000394A213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery