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TIMOTHY LEGG

Medical >> Physician Assistant >> Physician Assistants & Advanced Practice Nursing Providers

Registrant NPI Number: 1417598293

Individual Registrant:
 TIMOTHY  LEGG 
Gender: M
Sole Proprietor

Location and contact information for practice:
7TH & OKLAHOMA STE 5  LAVERNE, OK 73848-0987 US
Tel: 580-921-3355  Fax: --

Contact information for business:
PO BOX 336  BUFFALO, OK 73834-0336 US
Tel: 520-780-3920  Fax: --

Registration Information:
NPI: 1417598293
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y363AM0700XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant
Medical
OK3169

Legacy codes, insurance codes and state license numbers:

IssuerNumberStateType
200892080AOK05




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