Provider Demographics
NPI:1710540885
Name:JONES, LOGAN REED (DO)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:REED
Last Name:JONES
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:863 SUN PEAK WAY
Mailing Address - Street 2:
Mailing Address - City:TWIN FALLS
Mailing Address - State:ID
Mailing Address - Zip Code:83301-8977
Mailing Address - Country:US
Mailing Address - Phone:208-589-6588
Mailing Address - Fax:
Practice Address - Street 1:491 HERITAGE DR
Practice Address - Street 2:
Practice Address - City:JEROME
Practice Address - State:ID
Practice Address - Zip Code:83338-6701
Practice Address - Country:US
Practice Address - Phone:208-644-7507
Practice Address - Fax:208-644-7501
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-15
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDO-1489207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty