Active NPI
Mary Susan Leger
- Specialist
- Fort Walton Beach, FL
National Provider Identifier
1477806891
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- MA 50906
- Practice address
- 119 Truxton Ave
Fort Walton Beach, FL 32547-2460 - Phone
- (850) 862-4313
- NPI assigned
- Oct 23, 2012
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | MA 50906 | FL | Primary |
Addresses
Primary practice location
119 Truxton Ave
Fort Walton Beach, FL 32547-2460
Mailing address
107 Cristine CT
Niceville, FL 32578-4713
Phone (850) 496-0951
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MA 50906 | FL | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1350950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1350950400000",
"number": "1477806891",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "107 CRISTINE CT",
"city": "NICEVILLE",
"state": "FL",
"postal_code": "325784713",
"telephone_number": "850-496-0951"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "119 TRUXTON AVE",
"city": "FORT WALTON BEACH",
"state": "FL",
"postal_code": "325472460",
"telephone_number": "850-862-4313"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LEGER",
"first_name": "MARY",
"middle_name": "SUSAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2012-10-23",
"last_updated": "2012-10-23",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "FL",
"license": "MA 50906",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fort Walton Beach, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.