=====================================================
General NPI Number Information
=====================================================
NPI Number | 1881675221
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARC D LEGRAS MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/11/2005
-----------------------------------------------------
Last Update Date | 09/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 300 N GRAHAM ST STE 250
-----------------------------------------------------
City | PORTLAND
-----------------------------------------------------
State | OR
-----------------------------------------------------
Zip | 97227-1666
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-280-3418
-----------------------------------------------------
Fax | 503-284-7885
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 821350
-----------------------------------------------------
City | VANCOUVER
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98682-0030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 503-283-5220
-----------------------------------------------------
Fax | 503-283-9527
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | MD00033786
-----------------------------------------------------
License Number State | WA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2080P0202X
-----------------------------------------------------
Taxonomy Name | Pediatric Cardiology Physician
-----------------------------------------------------
License Number | MD19759
-----------------------------------------------------
License Number State | OR
-----------------------------------------------------