Healthcare Provider Details

I. General information

NPI: 1538492558
Provider Name (Legal Business Name): SCOTT LEGGOE D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2009
Last Update Date: 02/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11212 HIGHWAY 151
SAN ANTONIO TX
78251-4498
US

IV. Provider business mailing address

7703 FLOYD CURL DR
SAN ANTONIO TX
78229-3901
US

V. Phone/Fax

Practice location:
  • Phone: 210-450-9900
  • Fax:
Mailing address:
  • Phone: 210-450-9900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0000X
TaxonomyAdolescent Medicine (Family Medicine) Physician
License NumberR9801
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: