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General NPI Number Information
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NPI Number | 1477878940
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Entity Type | Organization
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Legal Business Name | LEGACY FAMILY MEDICINE LLC
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Dates
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Enumeration Date | 03/29/2010
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Last Update Date | 01/20/2015
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Provider Practice Location Address
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Address Line | 11602 LAKE UNDERHILL RD STE 119
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City | ORLANDO
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State | FL
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Zip | 32825-4460
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Country | US
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Telephone | 407-781-1000
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Fax | 407-781-1001
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Provider Business Mailing Address
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Address Line | 11602 LAKE UNDERHILL RD SUITE 119
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City | ORLANDO
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State | FL
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Zip | 32825-4458
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Country | US
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Telephone | 407-781-1000
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Fax | 407-781-1001
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Authorized Official
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Title or Position | PHYSICIAN/OWNER
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Name | PHILIP T HARDY
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Credential | MD
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Telephone | 407-781-1000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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