DR. BRUCE S LOGAN (NPI# 1841473121) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1841473121 |
| Entity Type | Individual |
| Full Name | DR. BRUCE S LOGAN |
| Credential | D.D.S. |
| Practice Address |
3162 State St Medford OR 97504-8450 |
| Practice Telephone | 5417797799 |
| Mailing Telephone | 5417797799 |
| Enumeration Date | 2007-12-10 |
| Last Update Date | 2020-07-17 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 1223S0112X |
Dentist Specialization: Oral and Maxillofacial Surgery |
5748 | OR | Dental Providers |
| N | 204E00000X | Oral & Maxillofacial Surgery | 5748 | OR | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OR | 239921 | 05 | |
| OR | CIGNA | 5132799 | 01 |
| OR | UNITED CONCORDIA | 000592926 | 01 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1154549087 | Bruce Alan Logan | Dentist | 22910 Crenshaw Blvd, Suite D, Torrance, CA 90505-3060 | 2007-04-23 |
| 1003966557 | Bruce Logan | Internal Medicine | 170 William St, Fl 7, New York, NY 10038-2612 | 2007-01-10 |
| Street Address |
3162 STATE ST |
| City | MEDFORD |
| State | OR |
| Zip Code | 97504-8450 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1093746174 | Southern Oregon Oral and Maxillofacial Surgeons | Dentist | 3162 State St, Medford, OR 97504-8450 | 2006-07-06 |
| 1467060293 | Omscor LLC | Dentist | 3162 State St, Medford, OR 97504-8450 | 2020-07-17 |
| 1639514672 | Matthew E Myers | Dentist | 3162 State St, Medford, OR 97504 | 2013-05-03 |
| 1588986525 | Oral and Maxillofacial Surgery | Dentist | 3162 State St, Medford, OR 97504-8450 | 2010-02-18 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225673833 | Lydia D Sneed | Behavioral Analyst | 3707 Citation Way, Suite 102, Medford, OR 97504 | 2019-11-07 |
| 1114577368 | Heather Ashley Fronek | Nurse Practitioner | 2825 E. Barnett Rd., Medford, OR 97504 | 2019-09-18 |
| 1255809109 | Justin Blasdel | Technician, Health Information | 3250 Lone Pine Rd, Medford, OR 97504 | 2018-11-08 |
| 1396220133 | Aimee K Michel | Massage Therapist | 3550 National Dr., Medford, OR 97504 | 2018-09-27 |
| 1437646908 | Zola Dental Medford LLC | Dentist | 922 E Main, Medford, OR 97504 | 2018-04-19 |
| 1376068015 | Megan Leggett | Counselor | 777 Murphy Road, Medford, OR 97504 | 2017-08-03 |
| 1023547536 | Joshua Morgan Rice | Dentist | 1117 E Main St Ste 1, Medford, OR 97504 | 2017-06-08 |
| 1427580232 | Paul James Dean | Counselor | 1175 Main St Ste 1c, Medford, OR 97504 | 2017-03-30 |
| 1811443542 | Taya Adams | Doula | 1201 Progress Dr #90, Medford, OR 97504 | 2016-09-01 |
| 1174076228 | Avalon Health Care - Hearthstone, LLC | Skilled Nursing Facility | 2091 E. Barnett Road, Medford, OR 97504 | 2016-07-25 |
| Find all providers in zip 97504 | ||||
| Taxonomy Code | 1223S0112X |
| Grouping | Dental Providers |
| Classification | Dentist |
| Specialization | Oral and Maxillofacial Surgery |
| The specialty of dentistry which includes the diagnosis, surgical and adjunctive treatment of diseases, injuries and defects involving both the functional and esthetic aspects of the hard and soft tissues of the oral and maxillofacial region. |
| Notes: Source: Council on Dental Education and Licensure, American Dental Association |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760665046 | Rajiv Rajagopal | Dentist | 1625 E Mcandrews Rd # A, Medford, OR 97504-5334 | 2007-12-10 |
| 1275608945 | Tony Woo | Dentist | 92 High St., Unit Dh 26, Medford, MA 02155 | 2006-11-21 |
| 1104859974 | Joseph L Matise | Dentist | 135 Jackson Rd, Laurel Professional Center - Suite A, Medford, NJ 08055-9231 | 2006-07-07 |
| 1386634418 | Michael J Doherty | Dentist | 460 Murphy Road, Medford, OR 97504 | 2005-10-28 |
| 1184625980 | Associates for Oral & Maxillofacial Surgery | Dentist | 1625 E Mcandrews Rd, #a, Medford, OR 97504-5334 | 2005-08-03 |
| 1467060293 | Omscor LLC | Dentist | 3162 State St, Medford, OR 97504-8450 | 2020-07-17 |
| 1639514672 | Matthew E Myers | Dentist | 3162 State St, Medford, OR 97504 | 2013-05-03 |
| 1588986525 | Oral and Maxillofacial Surgery | Dentist | 3162 State St, Medford, OR 97504-8450 | 2010-02-18 |
| 1205019585 | James D Savage | Dentist | 1625 E Mcandrews Rd # A, Medford, OR 97504-5334 | 2007-12-10 |
| 1922027820 | Amerigo J Fedeli | Dentist | 135 Jackson Rd, Laurel Professional Center - Suite A, Medford, NJ 08055-9231 | 2006-07-19 |
| Find all providers in MEDFORD | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.