Provider Demographics
NPI:1114287273
Name:LEGG, RUSSELL LAURENCE (MD)
Entity Type:Individual
Prefix:
First Name:RUSSELL
Middle Name:LAURENCE
Last Name:LEGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3920 S LONG LN
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:WA
Mailing Address - Zip Code:99016-8833
Mailing Address - Country:US
Mailing Address - Phone:614-625-5805
Mailing Address - Fax:
Practice Address - Street 1:124 E ROWAN AVE STE 101
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99207-1214
Practice Address - Country:US
Practice Address - Phone:509-487-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-23
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD.60674447207L00000X, 207LP2900X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program