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

Logan Tyler Boutwell, MD

Individual provider Student in an Organized Health Care Education/Training Program · NPI 1649029729

Logan Tyler Boutwell, MD is a Student in an Organized Health Care Education/Training Program in Gulfport, Mississippi. Licensed in Mississippi. Registered with an NPI since 2024.

Licensed in
MS
In the registry since
2024
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

4500 13th St
Gulfport, MS 39501-2515
Phone: (228) 867-4000
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Student in an Organized Health Care Education/Training Program (primary) Taxonomy 390200000X (MS)

Record details

NPI number1649029729
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorNo
NPI enumeratedMay 13, 2024
Last updated in NPPESMay 13, 2024
Certification dateMay 6, 2024

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