Provider Demographics
NPI:1538135868
Name:LOGAN, JOHN BRISBANE (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:BRISBANE
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29301 N DIXIE RANCH RD
Mailing Address - Street 2:
Mailing Address - City:LACOMBE
Mailing Address - State:LA
Mailing Address - Zip Code:70445
Mailing Address - Country:US
Mailing Address - Phone:985-871-4114
Mailing Address - Fax:985-871-4130
Practice Address - Street 1:29301 N DIXIE RANCH RD
Practice Address - Street 2:
Practice Address - City:LACOMBE
Practice Address - State:LA
Practice Address - Zip Code:70445
Practice Address - Country:US
Practice Address - Phone:985-871-4114
Practice Address - Fax:985-871-4130
Is Sole Proprietor?:No
Enumeration Date:2006-02-27
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020254207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAF63325Medicare UPIN
LAF63325Medicare UPIN