Healthcare Provider Details

I. General information

NPI: 1932543915
Provider Name (Legal Business Name): KENNETH W. LEGER MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/22/2013
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

203 E MILLER AVE STE B
IOWA LA
70647-4075
US

IV. Provider business mailing address

PO BOX 123604 DEPT 3604
DALLAS TX
75312-3604
US

V. Phone/Fax

Practice location:
  • Phone: 337-582-7632
  • Fax: 337-582-7656
Mailing address:
  • Phone: 337-494-2921
  • Fax: 337-494-6523

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number305225
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number305225
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: