Healthcare Provider Details

I. General information

NPI: 1114287273
Provider Name (Legal Business Name): RUSSELL LAURENCE LEGG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 E ROWAN AVE STE 101
SPOKANE WA
99207-1214
US

IV. Provider business mailing address

3920 S LONG LN
GREENACRES WA
99016-8833
US

V. Phone/Fax

Practice location:
  • Phone: 509-487-8000
  • Fax:
Mailing address:
  • Phone: 614-625-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberMD.60674447
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD.60674447
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: