Provider Demographics
NPI:1134006901
Name:LOGAN, MCPEARL HORTILLOSA (RNFA)
Entity type:Individual
Prefix:MRS
First Name:MCPEARL
Middle Name:HORTILLOSA
Last Name:LOGAN
Suffix:
Gender:F
Credentials:RNFA
Other - Prefix:
Other - First Name:MCPEARL
Other - Middle Name:HORTILLOSA
Other - Last Name:TEMPORAL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RNFA
Mailing Address - Street 1:909 ESE LOOP323 STE 777
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-9675
Mailing Address - Country:US
Mailing Address - Phone:903-606-8888
Mailing Address - Fax:903-606-8887
Practice Address - Street 1:909 ESE LOOP323 STE 777
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-9675
Practice Address - Country:US
Practice Address - Phone:903-606-8888
Practice Address - Fax:903-606-8887
Is Sole Proprietor?:No
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX----208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery