Individual
MARION S LEGROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
801 7TH AVE, FORT WORTH, TX 76104-2733
(682) 885-4054
(682) 885-7497
Mailing address
4100 INTERNATIONAL PLAZA, SUITE 600, FORT WORTH, TX 76109-4823
(817) 529-1923
(817) 877-0350
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
695838
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
137345809
MEDICAID GROUP
TX
01
—
140442853
CSHCN GROUP
TX
05
—
200923501
—
TX
01
—
200923502
CSHCN
TX
01
—
8904UA
BCBS
TX
Enumeration date
07/20/2007
Last updated
07/27/2011
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