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Individual

IGOR V LEGOSTAEV

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
344 FUNSTON PL, SAN ANTONIO, TX 78209-6819
(706) 767-3688
Mailing address
344 FUNSTON PL, SAN ANTONIO, TX 78209-6819
(706) 767-3688

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
58067
GA
208M00000X
Hospitalist Physician
Primary
U0150
TX

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
P00637907
RR MEDICARE
GA
Enumeration date
07/05/2006
Last updated
01/10/2023
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