MEDICARE: DR. JEFFREY LEGRETT M.D.

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	207R00000X	Internal Medicine Physician	211496-1	NY

General Provider Information

NPI Number	:	1548240278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY LEGRETT M.D.

Provider Business Mailing Address
First Line	:	77 NELSON ST
Second Line	:	SUITE 310
City	:	AUBURN
State	:	NY
Zip	:	13021-1944
Country	:	US
Telephone Number	:	315-253-4463
Fax Number	:	315-253-5624

Provider Business Practice Location Address
First Line	:	77 NELSON ST
Second Line	:	SUITE 310
City	:	AUBURN
State	:	NY
Zip	:	13021-1944
Country	:	US
Telephone Number	:	315-253-4463
Fax Number	:	315-253-5624

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

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	07/08/2007

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