Basic Information
| Provider Information | |||||||||
| NPI: | 1790704666 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGGINGTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8876 GULF FWY STE 215 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770176550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139479509 | ||||||||
| FaxNumber: | 7139470609 | ||||||||
| Practice Location | |||||||||
| Address1: | 8876 GULF FWY STE 215 | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770176550 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7139479509 | ||||||||
| FaxNumber: | 7139470609 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/19/2006 | ||||||||
| LastUpdateDate: | 02/03/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RN0300X | L6493 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Nephrology |
ID Information
| ID | Type | State | Issuer | Description | 174342901 | 05 | TX | MEDICAID |