Basic Information
| Provider Information | |||||||||
| NPI: | 1881675221 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LEGRAS | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | D | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 821350 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986820030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032835220 | ||||||||
| FaxNumber: | 5032839527 | ||||||||
| Practice Location | |||||||||
| Address1: | 300 N GRAHAM ST STE 250 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972271666 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032803418 | ||||||||
| FaxNumber: | 5032847885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/11/2005 | ||||||||
| LastUpdateDate: | 07/18/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 07/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0202X | MD00033786 | WA | N | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology | 2080P0202X | MD19759 | OR | Y | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Cardiology |
ID Information
| ID | Type | State | Issuer | Description | 1099118 | 05 | WA | MEDICAID | 081588 | 05 | OR | MEDICAID | 057775003 | 01 | OR | BLUE CROSS | OTHER |