Provider Demographics
NPI:1598841397
Name:LEGGETT, RANDI S (MD)
Entity Type:Individual
Prefix:
First Name:RANDI
Middle Name:S
Last Name:LEGGETT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1231 116TH AVE NE STE 525
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3804
Mailing Address - Country:US
Mailing Address - Phone:425-635-6910
Mailing Address - Fax:
Practice Address - Street 1:1231 116TH AVE NE STE 525
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3804
Practice Address - Country:US
Practice Address - Phone:425-635-6910
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00020211207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8127847Medicaid
5162OtherINTERNAL ID-MOTOR VEHICLE ID
D35772Medicare UPIN
WA000107939Medicare PIN
WA8127847Medicaid