Provider Demographics
NPI:1609222017
Name:LINTON, LOGAN B
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:B
Last Name:LINTON
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 1:2003 KOOTENAI HEALTH WAY
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-6051
Mailing Address - Country:US
Mailing Address - Phone:208-625-5200
Mailing Address - Fax:208-625-5201
Practice Address - Street 1:700 W IRONWOOD DR STE 341
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-4404
Practice Address - Country:US
Practice Address - Phone:208-625-5200
Practice Address - Fax:208-625-5201
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-05
Last Update Date:2021-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA53741363AM0700X
IDPA-2133363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical