Provider Demographics
NPI:1033288006
Name:LEBLEU, GREGORY EDMUND I (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:EDMUND
Last Name:LEBLEU
Suffix:I
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5203 SOUNDSIDE DR
Mailing Address - Street 2:
Mailing Address - City:GULF BREEZE
Mailing Address - State:FL
Mailing Address - Zip Code:32563-9314
Mailing Address - Country:US
Mailing Address - Phone:530-308-3462
Mailing Address - Fax:
Practice Address - Street 1:5203 SOUNDSIDE DR
Practice Address - Street 2:
Practice Address - City:GULF BREEZE
Practice Address - State:FL
Practice Address - Zip Code:32563-9314
Practice Address - Country:US
Practice Address - Phone:530-308-3462
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2017-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME131060208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX031300901Medicaid
TX00876DMedicare ID - Type Unspecified
TXF78518Medicare UPIN