MEDICARE: MR. KEVIN EDWARD LEGENDRE MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0202X	Diagnostic Radiology Physician	H8202	TX

General Provider Information

NPI Number	:	1417957952
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. KEVIN EDWARD LEGENDRE MD

Provider Business Mailing Address
First Line	:	2313 KINGSTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-6415
Country	:	US
Telephone Number	:	713-417-7533
Fax Number	:

Provider Business Practice Location Address
First Line	:	2313 KINGSTON ST
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77019-6415
Country	:	US
Telephone Number	:	713-417-7533
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/27/2005
Last Update Date	:	06/27/2014

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