Healthcare Provider Details

I. General information

NPI: 1063251502
Provider Name (Legal Business Name): LEGACY MD MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2024
Last Update Date: 02/24/2025
Certification Date: 02/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E COLE BLVD
CALEXICO CA
92231-3211
US

IV. Provider business mailing address

222 E COLE BLVD
CALEXICO CA
92231-3211
US

V. Phone/Fax

Practice location:
  • Phone: 760-352-2551
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOHN MARSHALL STRONG
Title or Position: PRESIDENT
Credential: MD
Phone: 760-352-2551