Provider Demographics
NPI:1871956011
Name:LEGG, ADAM JOSEPH (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:JOSEPH
Last Name:LEGG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 SE SALEM ST
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:64075-9299
Mailing Address - Country:US
Mailing Address - Phone:816-690-6566
Mailing Address - Fax:816-625-8276
Practice Address - Street 1:302 SE SALEM ST
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:MO
Practice Address - Zip Code:64075-9299
Practice Address - Country:US
Practice Address - Phone:816-690-6566
Practice Address - Fax:816-625-8276
Is Sole Proprietor?:No
Enumeration Date:2016-04-04
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2019022410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine