Provider Demographics
NPI:1770536773
Name:LOGAN, SARAH R (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:R
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10103 RIDGEGATE PKWY STE 221
Mailing Address - Street 2:
Mailing Address - City:LONE TREE
Mailing Address - State:CO
Mailing Address - Zip Code:80124-5525
Mailing Address - Country:US
Mailing Address - Phone:303-766-0197
Mailing Address - Fax:855-529-6802
Practice Address - Street 1:10103 RIDGEGATE PKWY STE 221
Practice Address - Street 2:
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-5525
Practice Address - Country:US
Practice Address - Phone:303-766-0197
Practice Address - Fax:855-529-6802
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO46236207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13927272Medicaid
ID000010147546OtherBLUE SHIELD
I14376Medicare UPIN
ID000010147546OtherBLUE SHIELD