Male or Other

Logan Mock PA

Physician Assistant in Fayetteville, NC(View on Map)

Full Name

Logan Mock PA

NPI Number

1578180006

NPI Type

Individual Provider

Gender

Male

Enumeration Date

06/30/2020

Specialties

(Taxonomies)

Code

363A00000X

Primary Taxonomy

Yes

Contact
Information

Purpose

Mailing
Location

Address

1638 OWEN DR
1638 OWEN DR

City

Fayetteville
Fayetteville

State

NC
NC

Postal Code

28304-3424
28304-3424

Country

US
US

Telephone Number

N/A
(843) 726-1470

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 02/12/2021

Provider Address

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