Provider Demographics
NPI:1285031633
Name:GERALD J. LEGLUE JR., M.D., APMC
Entity Type:Organization
Organization Name:GERALD J. LEGLUE JR., M.D., APMC
Other - Org Name:LEGLUE PHYSICAL MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTI
Authorized Official - Middle Name:
Authorized Official - Last Name:ANTEE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-442-8007
Mailing Address - Street 1:1270 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3055
Mailing Address - Country:US
Mailing Address - Phone:318-442-8007
Mailing Address - Fax:318-442-8334
Practice Address - Street 1:1270 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3055
Practice Address - Country:US
Practice Address - Phone:318-442-8007
Practice Address - Fax:318-442-8334
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-01
Last Update Date:2014-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAACU.200012171100000X
LA0184982081S0010X
LA01110F225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
No171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAE30276OtherUPIN