Provider Demographics
NPI:1780030999
Name:LEGAN, CARLEY
Entity type:Individual
Prefix:
First Name:CARLEY
Middle Name:
Last Name:LEGAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:399 W CAMPBELL RD STE 101
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-3615
Mailing Address - Country:US
Mailing Address - Phone:972-238-1848
Mailing Address - Fax:972-238-8735
Practice Address - Street 1:399 W CAMPBELL RD STE 101
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-3615
Practice Address - Country:US
Practice Address - Phone:972-238-1848
Practice Address - Fax:972-238-8735
Is Sole Proprietor?:No
Enumeration Date:2016-05-05
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXS0725207R00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine