Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.
NPIDirectory

Logan Roles

Individual provider Physician Assistant · NPI 1720887169

Logan Roles is a Physician Assistant in Oklahoma City, Oklahoma. Qualified in 2025, 1 year ago. Works from 2 locations. Licensed in Oklahoma.

Years since qualifying
1
Licensed in
OK
In the registry since
2025
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Practice location Address checks out

9800 Broadway Ext Ste 203
Oklahoma City, OK 73114-6304
Phone: (405) 424-5426
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 1102 W Macarthur St, Shawnee, OK 74804-1743 — (405) 273-2270

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 5576 (OK)

Record details

NPI number1720887169
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMarch 10, 2025
Last updated in NPPESJune 5, 2026
Certification dateJune 5, 2026

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2025 (1 years in practice)
Accepts Medicare assignment Not indicated
Practice locations3 on file with Medicare

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