# LEGACY VASCULAR LABS OF AMERICA PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1770107898
- **Authorized official:** JOHN RYAN (MANAGING MEMBER)
- **Authorized official phone:** (972) 345-7890

## Contact information

- **Practice address:** 7711 SAN JACINTO PL STE 200, PLANO, TX 75024-3296
- **Practice address phone:** (972) 345-7890
- **Mailing address:** PO BOX 191634, DALLAS, TX 75219-8503

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 2086S0129X | Vascular Surgery Physician | — | NULL | Yes |
| 2086S0129X | Vascular Surgery Physician | — | — | Yes |

## Other

- **Enumeration date:** 06/04/2020
- **Last updated:** 10/18/2022