Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | 228012 | MA |
Y | 207KA0200X | Allergist | N0209 | TX |
N | 208000000X | Pediatrician | A84051 | CA |
NPI | 1669464723 |
---|---|
Provider Name | Dr. Henry Joseph Legere III |
First Address | Austin, TX 78759 |
Second Address | Austin, TX 78746 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/08/2005 |
Last Update Date | 22/02/2021 |