Provider Demographics
NPI:1225168628
Name:LEGGITT, DONALD R
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:R
Last Name:LEGGITT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17441 E TRAILS END RD
Mailing Address - Street 2:
Mailing Address - City:MAYER
Mailing Address - State:AZ
Mailing Address - Zip Code:86333-4317
Mailing Address - Country:US
Mailing Address - Phone:928-632-4857
Mailing Address - Fax:
Practice Address - Street 1:17441 E TRAILS END RD
Practice Address - Street 2:
Practice Address - City:MAYER
Practice Address - State:AZ
Practice Address - Zip Code:86333-4317
Practice Address - Country:US
Practice Address - Phone:928-632-4857
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ040584OtherAHCCCS ID