| Legent Physician Group Pllc | |
|
5330 N Loop 1604 W Ste 102 San Antonio TX 78249-4384 | |
| (210) 819-4562 | |
| Not Available |
| Full Name | Legent Physician Group Pllc |
|---|---|
| Speciality | Orthopaedic Surgery |
| Location | 5330 N Loop 1604 W Ste 102, San Antonio, Texas |
| Authorized Official Name and Position | Daniel Brazell (CHIEF OPERATING OFFICER) |
| Authorized Official Contact | 3103396824 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Legent Physician Group Pllc 2722 W Bitters Rd Ste 125 San Antonio TX 78248-1235 Ph: (726) 800-6084 | Legent Physician Group Pllc 5330 N Loop 1604 W Ste 102 San Antonio TX 78249-4384 Ph: (210) 819-4562 |
| NPI Number | 1265142038 |
|---|---|
| Provider Enumeration Date | 12/01/2022 |
| Last Update Date | 12/22/2023 |
| Medicare PECOS PAC ID | 5294104949 |
|---|---|
| Medicare Enrollment ID | O20221220000543 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1265142038 | NPI | - | NPPES |
| Provider Name | Jordan J Jude |
|---|---|
| Provider Type | Practitioner - Neurosurgery |
| Provider Identifiers | NPI Number: 1255533451 PECOS PAC ID: 8426157538 Enrollment ID: I20080822000382 |
| Provider Name | Robert Gordon Johnson |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1689675142 PECOS PAC ID: 0042229833 Enrollment ID: I20100427000243 |
| Provider Name | Brian N Kanz |
|---|---|
| Provider Type | Practitioner - Orthopedic Surgery |
| Provider Identifiers | NPI Number: 1184815367 PECOS PAC ID: 5294981742 Enrollment ID: I20120815000828 |
| Provider Name | Brandon Phillip Bell |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1154932630 PECOS PAC ID: 8820405723 Enrollment ID: I20210319001425 |
| Provider Name | Rosalino Evier Lara |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1427833292 PECOS PAC ID: 2163886011 Enrollment ID: I20230912001294 |
| Provider Name | Chavernay Perron |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1538851548 PECOS PAC ID: 6709235203 Enrollment ID: I20231208002927 |
| Provider Name | Justin Anthony Riojas |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1942762232 PECOS PAC ID: 2163881509 Enrollment ID: I20240216000906 |
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