Provider Demographics
NPI:1285732859
Name:LOGAN, JOY L (MD)
Entity type:Individual
Prefix:
First Name:JOY
Middle Name:L
Last Name:LOGAN
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:6622 N 91ST AVE STE 220
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85305-2569
Mailing Address - Country:US
Mailing Address - Phone:602-759-6883
Mailing Address - Fax:602-224-3358
Practice Address - Street 1:4475 S L-19 FRONTAGE ROAD
Practice Address - Street 2:SUITE 101
Practice Address - City:GREEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85614
Practice Address - Country:US
Practice Address - Phone:520-585-4590
Practice Address - Fax:520-398-7540
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2018-06-28
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Provider Licenses
StateLicense IDTaxonomies
AZ10447207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ241711Medicaid
AZ122320Medicare PIN
AZ122320Medicare PIN
AZ122321Medicare PIN