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Individual

JIMMY LEGROS III

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
NP

Contact information

Practice address
3975 I 49 S SERVICE RD, 234, OPELOUSAS, LA 70570-0775
(337) 942-8694
(337) 942-8696
Mailing address
PO BOX 52453, LAFAYETTE, LA 70505-2453
(337) 942-8694
(337) 942-8696

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
RN070188 - AP03265
LA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1541435
LA
Enumeration date
07/07/2005
Last updated
11/03/2008
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