DR. JASON M LOGAN (NPI# 1619985447) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1619985447 |
| Entity Type | Individual |
| Full Name | DR. JASON M LOGAN |
| Credential | MD |
| Practice Address |
1540 South Lake St Forest Lake MN 55025-2628 |
| Mailing Address |
2925 Chicago Ave Minneapolis MN 55407-1321 |
| Practice Telephone | 6514647100 |
| Mailing Telephone | 6122625000 |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2011-11-29 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 51178 | MN | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1245220144 | Jason A. Logan | Emergency Medicine | 7600 S Lewis Ave, Tulsa, OK 74136-6836 | 2005-10-24 |
| 1871785154 | Jason Scott Logan | Physical Therapist | 126 Missouri Ave, General Leonard Wood Army Community Hospital, Ft. Leonard Wood, MO 65473 | 2007-08-10 |
| Street Address |
1540 SOUTH LAKE ST |
| City | FOREST LAKE |
| State | MN |
| Zip Code | 55025-2628 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1043846173 | Persistence Physical Therapy LLC | Clinic/Center | 2009 W Broadway Ave, Ste 400 Pmb 131, Forest Lake, MN 55025 | 2020-03-20 |
| 1255973319 | Connie Rettig | Technician | 908 North Shore Drive, Forest Lake, MN 55025 | 2019-10-10 |
| 1003394479 | Malissa Ann Costanzo | Community Based Residential Treatment, Mental Retardation and/or Developmental Disabilities | 844 8th Ave Se, Forest Lake, MN 55025 | 2018-07-30 |
| 1669754735 | Brent Alan Millard | Pharmacist | 1207 West Broadway Ave, Forest Lake, MN 55025 | 2011-09-15 |
| 1982842167 | Lakes Center for Youth and Families | Community/Behavioral Health | 20 N Lake Street, Suite 103, Forest Lake, MN 55025 | 2009-01-27 |
| 1487843355 | Paul Luke Mladnick | Marriage & Family Therapist | 1068 So Lake St, #109, Forest Lake, MN 55025 | 2007-10-17 |
| 1740477678 | Rita Lynn Scanlan | Occupational Therapist | 604 Ne 1st St, Birchwood Health Care Center, Forest Lake, MN 55025 | 2007-09-25 |
| 1114053113 | Senior Care Forest Lake, LLC | Skilled Nursing Facility | 604 N.e. First Street, Forest Lake, MN 55025 | 2007-02-26 |
| 1073672101 | Catharine B Ruther | Dentist | 956 West Broadway, Lakes Dental Clinic, Forest Lake, MN 55025 | 2006-12-06 |
| 1407914849 | Ervin George Savord | Dentist | 255 Highway 97, Suite 1b, Forest Lake, MN 55025 | 2006-12-05 |
| Find all providers in zip 55025 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104808534 | C Scott Kammer | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2005-11-20 |
| 1760774574 | Kelsey Lee Hultman | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2011-05-11 |
| 1619266608 | Benjamin Dashiell Lambertson | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2011-03-31 |
| 1023252731 | Oluwakemi Tinuke Olowoyo | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2009-04-24 |
| 1306011416 | Brett J Salek | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2008-04-29 |
| 1033393178 | Vivian Lilly Wireko-brobby | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2007-12-26 |
| 1255479879 | Steven Duane Semmler | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2007-02-03 |
| 1588749642 | Donald Wayne Kjome | Family Medicine | 967 Lake St S, Forest Lake, MN 55025-2616 | 2006-10-26 |
| 1538251475 | Steven Henry Voss | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2006-09-29 |
| 1255383360 | Linda Wilkes Asadourian | Family Medicine | 1540 Lake St S, Forest Lake, MN 55025-2628 | 2006-05-17 |
| Find all providers in FOREST LAKE | ||||
| City | FOREST LAKE |
| Zip Code | 55025 |
Please comment or provide details below to improve the information on DR. JASON M LOGAN.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.