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General NPI Number Information
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NPI Number | 1588554901
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Entity Type | Individual
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Provider Name | GARY F LEGROS III NP
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Gender | Male
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Dates
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Enumeration Date | 07/07/2025
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 2390 W CONGRESS ST
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City | LAFAYETTE
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State | LA
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Zip | 70506-4205
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Country | US
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Telephone | 337-261-6000
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Fax |
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Provider Business Mailing Address
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Address Line | 209 HIGHLAND PARK LN
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City | LAFAYETTE
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State | LA
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Zip | 70508-5641
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Country | US
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Telephone | 337-380-8616
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 205847
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163WC0200X
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Taxonomy Name | Critical Care Medicine Registered Nurse
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License Number | 205847
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License Number State | LA
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Taxonomy #3
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 205847
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License Number State | LA
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