Provider Demographics
NPI:1790928505
Name:MAST, LOGAN E (MD)
Entity Type:Individual
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First Name:LOGAN
Middle Name:E
Last Name:MAST
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Gender:M
Credentials:MD
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Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-587-8222
Mailing Address - Fax:502-587-0860
Practice Address - Street 1:201 ABRAHAM FLEXNER WAY
Practice Address - Street 2:SUITE 100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-3841
Practice Address - Country:US
Practice Address - Phone:502-587-8222
Practice Address - Fax:502-587-0860
Is Sole Proprietor?:No
Enumeration Date:2009-04-08
Last Update Date:2015-09-15
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Provider Licenses
StateLicense IDTaxonomies
KY47966207X00000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYK180100Medicare PIN