Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 018498 | LA |
NPI | 1013919745 |
---|---|
Provider Name | Dr. Gerald J Leglue JR. |
First Address | Alexandria, LA 71303-3055 |
Second Address | Alexandria, LA 71303-3055 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2005 |
Last Update Date | 05/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1397466 | (05) | LA |
E30276 | (02) | LA |