Provider Demographics
NPI:1205548864
Name:WEATHERFORD, LOGAN HAYES (NEURPHYSIOLOGIST)
Entity type:Individual
Prefix:MR
First Name:LOGAN
Middle Name:HAYES
Last Name:WEATHERFORD
Suffix:
Gender:M
Credentials:NEURPHYSIOLOGIST
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7455 W WASHINGTON AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-4340
Mailing Address - Country:US
Mailing Address - Phone:217-649-6664
Mailing Address - Fax:
Practice Address - Street 1:7455 W WASHINGTON AVE STE 302
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-4340
Practice Address - Country:US
Practice Address - Phone:217-649-6664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-14
Last Update Date:2022-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnostic