Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | OS007474E | PA |
NPI | 1013951276 |
---|---|
Provider Name | Dr. John B Legere |
First Address | Lancaster, PA 17602-2729 |
Second Address | Lancaster, PA 17602-2729 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/06/2006 |
Last Update Date | 02/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02022801 | CAP. BLUE CROSS (01) | PA |
070003591 | RR MEDICARE (01) | PA |
562900 | AETNA (01) | PA |
671190 | BLUE SHIELD (01) | PA |