Provider Demographics
NPI:1548240278
Name:LEGRETT, JEFFREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:
Last Name:LEGRETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:77 NELSON ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:AUBURN
Mailing Address - State:NY
Mailing Address - Zip Code:13021-1944
Mailing Address - Country:US
Mailing Address - Phone:315-253-4463
Mailing Address - Fax:315-253-5624
Practice Address - Street 1:77 NELSON ST
Practice Address - Street 2:SUITE 310
Practice Address - City:AUBURN
Practice Address - State:NY
Practice Address - Zip Code:13021-1944
Practice Address - Country:US
Practice Address - Phone:315-253-4463
Practice Address - Fax:315-253-5624
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY211496-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYH16880Medicare UPIN