Provider Demographics
NPI:1518221233
Name:LOGAN, REBECCA LORRAINE (DO)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:LORRAINE
Last Name:LOGAN
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:2695 ROCKY MOUNTAIN AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-9071
Mailing Address - Country:US
Mailing Address - Phone:970-624-4123
Mailing Address - Fax:970-624-2416
Practice Address - Street 1:4323 INTEGRITY CENTER PT
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80917-1683
Practice Address - Country:US
Practice Address - Phone:719-591-2558
Practice Address - Fax:719-365-7680
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2023-10-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NE1150207Q00000X
COCDR.0001348207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine