Provider Demographics
NPI:1013908771
Name:LEGROW, ROBERT STEVEN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:STEVEN
Last Name:LEGROW
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1428 COUNTRY CLUB LN
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:WI
Mailing Address - Zip Code:53098-4345
Mailing Address - Country:US
Mailing Address - Phone:920-261-8500
Mailing Address - Fax:920-261-8828
Practice Address - Street 1:127 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:WI
Practice Address - Zip Code:53098-3303
Practice Address - Country:US
Practice Address - Phone:920-261-8500
Practice Address - Fax:920-261-8828
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2022-04-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXM3819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
INI19815Medicare UPIN