Provider Demographics
NPI:1659449916
Name:LEGGETT MEDICAL GROUP INC
Entity Type:Organization
Organization Name:LEGGETT MEDICAL GROUP INC
Other - Org Name:LEGGETT MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LEGGETT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:941-685-8914
Mailing Address - Street 1:651 SE 41ST AVE
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:FL
Mailing Address - Zip Code:32693-5003
Mailing Address - Country:US
Mailing Address - Phone:941-685-8914
Mailing Address - Fax:
Practice Address - Street 1:3896 EASTON ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34238-2601
Practice Address - Country:US
Practice Address - Phone:941-365-2434
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-02
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207QA0505X, 207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL57800Medicare ID - Type Unspecified