Provider Demographics
NPI:1366896094
Name:HALL, LOGAN
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:
Last Name:HALL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1356 ROYALTY CT
Mailing Address - Street 2:APT 13
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2853
Mailing Address - Country:US
Mailing Address - Phone:270-625-9730
Mailing Address - Fax:
Practice Address - Street 1:800 ROSE ST
Practice Address - Street 2:PAVILION H
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40536-7001
Practice Address - Country:US
Practice Address - Phone:859-323-1144
Practice Address - Fax:859-323-7633
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program