Healthcare Provider Details

I. General information

NPI: 1659449916
Provider Name (Legal Business Name): LEGGETT MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/02/2006
Last Update Date: 01/05/2023
Certification Date: 01/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3896 EASTON ST
SARASOTA FL
34238-2601
US

IV. Provider business mailing address

651 SE 41ST AVE
TRENTON FL
32693-5003
US

V. Phone/Fax

Practice location:
  • Phone: 941-365-2434
  • Fax:
Mailing address:
  • Phone: 941-685-8914
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License Number
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License Number
License Number StateFL

VIII. Authorized Official

Name: DAVID LEGGETT
Title or Position: PRACTICE MANAGER
Credential:
Phone: 941-685-8914