Provider Demographics
NPI:1942922562
Name:SCOTT, LOGAN JAMES (PA-C)
Entity Type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:JAMES
Last Name:SCOTT
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2702 NAVARRE AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3224
Mailing Address - Country:US
Mailing Address - Phone:419-442-0222
Mailing Address - Fax:419-696-7015
Practice Address - Street 1:2702 NAVARRE AVE STE 102
Practice Address - Street 2:
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3224
Practice Address - Country:US
Practice Address - Phone:419-442-0222
Practice Address - Fax:419-696-7015
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-12
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH50.008401RX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant