Provider Demographics
NPI:1013951276
Name:LEGERE, JOHN B (DO)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:B
Last Name:LEGERE
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 N LIME ST
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:PA
Mailing Address - Zip Code:17602-2729
Mailing Address - Country:US
Mailing Address - Phone:717-392-6267
Mailing Address - Fax:
Practice Address - Street 1:203 N LIME ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2729
Practice Address - Country:US
Practice Address - Phone:717-392-6267
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2008-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS007474E207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA02022801OtherCAP. BLUE CROSS
PA671190OtherBLUE SHIELD
PA070003591OtherRR MEDICARE
PA562900OtherAETNA
PA562900OtherAETNA