Provider Demographics
NPI:1386076206
Name:LOGAN, MARCIA ELIZABETH
Entity type:Individual
Prefix:
First Name:MARCIA
Middle Name:ELIZABETH
Last Name:LOGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25543 CANYON CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:TX
Mailing Address - Zip Code:77406-7278
Mailing Address - Country:US
Mailing Address - Phone:713-806-7500
Mailing Address - Fax:832-535-3794
Practice Address - Street 1:25543 CANYON CROSSING DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:TX
Practice Address - Zip Code:77406-7278
Practice Address - Country:US
Practice Address - Phone:713-806-7500
Practice Address - Fax:832-535-3794
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist