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NPI Code Detail

MEDICARE: JILL LEGG

MEDICARE:   JILL  LEGG
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
1207Q00000XFamily Medicine PhysicianG62719CA

General Provider Information

NPI Number : 1881771624
Entity Type Code : Individual
Provider Name (Legal Business Name) : JILL LEGG
Provider Business Mailing Address
First Line : PO BOX 2520
Second Line :
City : BERKELEY
State : CA
Zip : 94702-0520
Country : US
Telephone Number : 510-535-4410
Fax Number : 510-261-6438
Provider Business Practice Location Address
First Line : 2950 INTERNATIONAL BLVD
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2228
Country : US
Telephone Number : 510-535-4410
Fax Number : 510-261-6438
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/01/2006
Last Update Date : 02/13/2012

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Directions to “ JILL LEGG ” Practice Location

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