Provider Demographics
NPI:1376712927
Name:R.J. LEGREID II, MD
Entity Type:Organization
Organization Name:R.J. LEGREID II, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDISENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RUSSEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:LEGREID
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:931-363-0434
Mailing Address - Street 1:1255 E COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PULASKI
Mailing Address - State:TN
Mailing Address - Zip Code:38478-4515
Mailing Address - Country:US
Mailing Address - Phone:931-363-0343
Mailing Address - Fax:931-363-2604
Practice Address - Street 1:1255 E COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PULASKI
Practice Address - State:TN
Practice Address - Zip Code:38478-4515
Practice Address - Country:US
Practice Address - Phone:931-363-0343
Practice Address - Fax:931-363-2604
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN39319174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3728367Medicare PIN