Lettis Logan, Stacey M
Lettis Logan, Stacey M is an sole proprietor health care provider with primary practice located at 2925 Debarr Rd Suite 230, Anchorage AK 99508-2959. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Lettis Logan, Stacey M can be contacted via phone (907) 777-1800.Contact Information
Primary practice address
2925 Debarr Rd Suite 230
Anchorage AK 99508-2959
Phone: (907) 777-1800
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 7772 | Alaska |
Profile Details
| NPI number | 1972765774 |
|---|---|
| LBN Legal business name | Lettis Logan, Stacey M |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Jul 2nd, 2008 |
| Last updated | Jun 29th, 2016 - about 9 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1972765774 | NPPES |
| Alaska | MEDICAID | 1585092 |
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