Provider Demographics
NPI:1023124377
Name:LOGAN, SEAN RAYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:SEAN
Middle Name:RAYMOND
Last Name:LOGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:801 MEDICAL DR STE A
Mailing Address - Street 2:
Mailing Address - City:LIMA
Mailing Address - State:OH
Mailing Address - Zip Code:45804-4030
Mailing Address - Country:US
Mailing Address - Phone:419-222-6622
Mailing Address - Fax:419-224-0015
Practice Address - Street 1:1501 BRIGHT RD
Practice Address - Street 2:
Practice Address - City:FINDLAY
Practice Address - State:OH
Practice Address - Zip Code:45840-5463
Practice Address - Country:US
Practice Address - Phone:419-222-6622
Practice Address - Fax:419-224-0015
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35051273207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0875683Medicaid
OHF27523Medicare UPIN
OH0716568Medicare PIN