Provider Demographics
NPI:1639266380
Name:LEGROS, TRACY LEIGH (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:TRACY
Middle Name:LEIGH
Last Name:LEGROS
Suffix:
Gender:F
Credentials:MD, PHD
Other - Prefix:
Other - First Name:TRACY
Other - Middle Name:L
Other - Last Name:MURRELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, PHD
Mailing Address - Street 1:921 HAGAN AVE
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-3914
Mailing Address - Country:US
Mailing Address - Phone:504-488-5692
Mailing Address - Fax:
Practice Address - Street 1:877 JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38103-2807
Practice Address - Country:US
Practice Address - Phone:504-439-1233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-06
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA023742207P00000X
TN63454207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1484849Medicaid
LA1484849Medicaid