Provider Demographics
NPI:1841435997
Name:LOGAN, COQUICE
Entity type:Individual
Prefix:
First Name:COQUICE
Middle Name:
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 1:6312 SNOW RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76018-3160
Mailing Address - Country:US
Mailing Address - Phone:817-468-3847
Mailing Address - Fax:817-468-5977
Practice Address - Street 1:6312 SNOW RIDGE CT
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76018-3160
Practice Address - Country:US
Practice Address - Phone:817-468-3847
Practice Address - Fax:817-468-5977
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment