Individual
TIMOTHY LEGG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
7TH & OKLAHOMA STE 5, LAVERNE, OK 73848-0987
(580) 921-3355
Mailing address
PO BOX 336, BUFFALO, OK 73834-0336
(520) 780-3920
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
3169
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200892080A
—
OK
Enumeration date
10/03/2019
Last updated
12/22/2020
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