Provider Demographics
NPI:1013919745
Name:LEGLUE, GERALD J JR (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:J
Last Name:LEGLUE
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:1270 SOUTHAMPTON DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71303-3055
Mailing Address - Country:US
Mailing Address - Phone:318-442-8007
Mailing Address - Fax:318-442-1822
Practice Address - Street 1:1270 SOUTHAMPTON DR
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-3055
Practice Address - Country:US
Practice Address - Phone:318-442-8007
Practice Address - Fax:318-442-1822
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2019-06-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
LA018498208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1397466Medicaid
LA1397466Medicaid
LA5L052Medicare ID - Type Unspecified