Provider Demographics
NPI:1063613057
Name:LOGAN & PETERSON, PC
Entity type:Organization
Organization Name:LOGAN & PETERSON, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP,TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:E
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:816-842-2500
Mailing Address - Street 1:428 W 42ND ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64111-3176
Mailing Address - Country:US
Mailing Address - Phone:816-842-2500
Mailing Address - Fax:816-842-9980
Practice Address - Street 1:428 W 42ND ST
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-3176
Practice Address - Country:US
Practice Address - Phone:816-842-2500
Practice Address - Fax:816-842-9980
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR7B57261QM2500X
MOMDR5P261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty