Provider Demographics
NPI:1124361506
Name:LEGACY PHYSICIANS GROUP
Entity Type:Organization
Organization Name:LEGACY PHYSICIANS GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:SPIRIDES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-668-5400
Mailing Address - Street 1:7460 WARREN PARKWAY
Mailing Address - Street 2:160 LEGACY PHYSICIANS GROUP.
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75034
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7460 WARREN PKWY
Practice Address - Street 2:160
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4169
Practice Address - Country:US
Practice Address - Phone:972-668-5400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-03
Last Update Date:2013-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX819412363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty