Provider Demographics
NPI:1669431243
Name:LEGGETT, PHILIP L (MD)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:L
Last Name:LEGGETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 PEAKWOOD DR
Mailing Address - Street 2:SUITE 8B
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77090-2900
Mailing Address - Country:US
Mailing Address - Phone:281-580-6797
Mailing Address - Fax:281-580-6693
Practice Address - Street 1:800 PEAKWOOD DR
Practice Address - Street 2:SUITE 8B
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77090-2900
Practice Address - Country:US
Practice Address - Phone:281-580-6797
Practice Address - Fax:281-580-6693
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-21
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF6871174400000X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000F15H8Medicaid
TXB24318Medicare UPIN
TXF15HMedicare ID - Type Unspecified