Provider Demographics
NPI:1336429158
Name:JENNIFER LOGAN, M.D., LLC
Entity Type:Organization
Organization Name:JENNIFER LOGAN, M.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:P
Authorized Official - Last Name:LOGAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-372-0696
Mailing Address - Street 1:6715 ANTIGUA DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-9433
Mailing Address - Country:US
Mailing Address - Phone:970-372-0696
Mailing Address - Fax:970-372-0696
Practice Address - Street 1:6715 ANTIGUA DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-9433
Practice Address - Country:US
Practice Address - Phone:970-372-0696
Practice Address - Fax:970-372-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty