Provider Demographics
NPI:1639167604
Name:LEGATH, FRANCIS BUDDY (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:BUDDY
Last Name:LEGATH
Suffix:
Gender:M
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1118 CLUB DR
Mailing Address - Street 2:
Mailing Address - City:JOHNSTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15905-1914
Mailing Address - Country:US
Mailing Address - Phone:814-255-4406
Mailing Address - Fax:
Practice Address - Street 1:1118 CLUB DR
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:PA
Practice Address - Zip Code:15905-1914
Practice Address - Country:US
Practice Address - Phone:814-255-4406
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA002052L363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAS38366Medicare UPIN
PA088285QJVMedicare ID - Type Unspecified