Provider Demographics
NPI:1295597326
Name:BRUFFETT, LOGAN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:BRUFFETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 N BONNIE BRAE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76201-3748
Mailing Address - Country:US
Mailing Address - Phone:940-382-1718
Mailing Address - Fax:940-380-8222
Practice Address - Street 1:209 N BONNIE BRAE ST STE 205
Practice Address - Street 2:
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76201-3748
Practice Address - Country:US
Practice Address - Phone:940-382-1718
Practice Address - Fax:940-380-8222
Is Sole Proprietor?:No
Enumeration Date:2024-01-24
Last Update Date:2024-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant