Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080P0214X | Pediatric Pulmonologist | 20975 | AZ |
NPI | 1336112192 |
---|---|
Provider Name | Dr. Gregory J Legris |
First Address | Phoenix, AZ 85013-4215 |
Second Address | Phoenix, AZ 85013-4224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2006 |
Last Update Date | 20/09/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A80711 | (02) |