Provider Demographics
NPI:1851702716
Name:INNERS LOGAN, LAUREN DANIELLE (DO)
Entity type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:DANIELLE
Last Name:INNERS LOGAN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:DANIELLE
Other - Last Name:INNERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:2828 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:25702-1236
Mailing Address - Country:US
Mailing Address - Phone:304-525-6905
Mailing Address - Fax:
Practice Address - Street 1:2828 1ST AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25702-1236
Practice Address - Country:US
Practice Address - Phone:304-525-6905
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-14
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS017796207QS0010X
WV4307207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine