Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207X00000X | Orthopaedic Surgeon | 6107573-1205 | UT |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 11437 | MT |
NPI | 1043262140 |
---|---|
Provider Name | Alexander Benton Legrand |
First Address | Bozeman, MT 59715-8812 |
Second Address | Bozeman, MT 59715-8812 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/05/2006 |
Last Update Date | 22/06/2011 |