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General NPI Number Information
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NPI Number | 1265142038
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Entity Type | Organization
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Legal Business Name | LEGENT PHYSICIAN GROUP PLLC
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Dates
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Enumeration Date | 12/01/2022
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Last Update Date | 12/04/2025
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Provider Practice Location Address
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Address Line | 5330 N LOOP 1604 W STE 102
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City | SAN ANTONIO
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State | TX
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Zip | 78249-4384
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Country | US
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Telephone | 210-819-4562
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Fax |
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Provider Business Mailing Address
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Address Line | 2722 W BITTERS RD STE 125
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City | SAN ANTONIO
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State | TX
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Zip | 78248-1235
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Country | US
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Telephone | 726-800-6084
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Fax | 469-210-1821
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DANIEL BRAZELL
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Credential |
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Telephone | 310-339-6824
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 225100000X
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Taxonomy Name | Physical Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207T00000X
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Taxonomy Name | Neurological Surgery Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number |
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License Number State |
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