Provider Demographics
NPI:1841462280
Name:LEGUM, LOUIS (PHD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:LEGUM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:PALATKA
Mailing Address - State:FL
Mailing Address - Zip Code:32177-4741
Mailing Address - Country:US
Mailing Address - Phone:386-326-4009
Mailing Address - Fax:386-328-7733
Practice Address - Street 1:421 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:PALATKA
Practice Address - State:FL
Practice Address - Zip Code:32177-4741
Practice Address - Country:US
Practice Address - Phone:386-326-4009
Practice Address - Fax:386-328-7733
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-26
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY2384103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75226YMedicare UPIN