Provider Demographics
NPI:1679659239
Name:LOGAN, BOBBY ROYCE (RRT-NPS/RPSGT)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:ROYCE
Last Name:LOGAN
Suffix:
Gender:M
Credentials:RRT-NPS/RPSGT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3602 86TH ST
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79423-2647
Mailing Address - Country:US
Mailing Address - Phone:806-470-9420
Mailing Address - Fax:806-745-5171
Practice Address - Street 1:3602 86TH ST
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79423-2647
Practice Address - Country:US
Practice Address - Phone:806-470-9420
Practice Address - Fax:806-745-5171
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX572242279P3900X
NM24632279P3900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2279P3900XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRespiratory Therapist, RegisteredNeonatal/Pediatrics