Provider Demographics
NPI:1972646115
Name:ROOTS, LOGAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:LOGAN
Middle Name:H
Last Name:ROOTS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:431 SAINT MICHAELS DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-8607
Mailing Address - Country:US
Mailing Address - Phone:505-238-2997
Mailing Address - Fax:505-890-7944
Practice Address - Street 1:431 SAINT MICHAELS DR
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-8607
Practice Address - Country:US
Practice Address - Phone:505-238-2997
Practice Address - Fax:505-890-7944
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
NM73-197207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
C98061Medicare UPIN