Provider Demographics
NPI:1093850364
Name:LEBLANC, GAIRY
Entity Type:Individual
Prefix:MR
First Name:GAIRY
Middle Name:
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9235 GROUPER RD
Mailing Address - Street 2:USCGC CONFIDENCE
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-4402
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:9235 GROUPER RD
Practice Address - Street 2:USCGC CONFIDENCE
Practice Address - City:CAPE CANAVERAL
Practice Address - State:FL
Practice Address - Zip Code:32920-4402
Practice Address - Country:US
Practice Address - Phone:703-731-2433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians
Not Answered247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other