Individual
DR. RUSSEL JEROME LEGREID II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1026 S MAIN ST, BLUFFTON, IN 46714-3614
(260) 353-2023
(260) 824-7244
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3513
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
01074428A
IN
174400000X
Specialist
39319
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407897978
—
WI
05
—
201250850
—
IN
Enumeration date
06/08/2006
Last updated
07/21/2022
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