| Doctor Name: | DR. BRIAN WADE LEGENDRE |
| NPI Number: | 1487723318 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.D. |
| License Number: | A92256 |
| Business Practice Address: | 1st Lar Battalion - Bas - Medical Officer Box 555564 Camp Pendleton, CA - 92055 |
| Business Phone Number: | 7607252873 |
| Business Fax Number: | |
| Mailing Address: | Box 555564, 1st Lar Battalion - Bas - Medical Officer CAMP PENDLETON |
| State: | CA |
| Postal Code: | 92055 |
| Phone Number: | 7607252873 |
| Fax Number: | |
| NPI Enumeration Date: | 11/07/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | A92256 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |