Provider Demographics
NPI:1730765637
Name:BIANCHI, LOGAN L (PA)
Entity type:Individual
Prefix:
First Name:LOGAN
Middle Name:L
Last Name:BIANCHI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:715 S 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CANON CITY
Mailing Address - State:CO
Mailing Address - Zip Code:81212-4911
Mailing Address - Country:US
Mailing Address - Phone:719-269-8820
Mailing Address - Fax:719-204-0230
Practice Address - Street 1:4404 BARRANCA LN STE 101
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80104-7419
Practice Address - Country:US
Practice Address - Phone:720-733-5260
Practice Address - Fax:720-733-5261
Is Sole Proprietor?:No
Enumeration Date:2021-03-22
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORPA219016363A00000X
COPA.0006652363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant