Provider Demographics
NPI:1336133826
Name:LEBLANC, HEATHER N (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:N
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1609 W 40TH AVE
Mailing Address - Street 2:SUITE 403
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71603-6319
Mailing Address - Country:US
Mailing Address - Phone:870-534-4188
Mailing Address - Fax:870-534-7964
Practice Address - Street 1:1609 W 40TH AVE
Practice Address - Street 2:SUITE 403
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71603-6319
Practice Address - Country:US
Practice Address - Phone:870-534-4188
Practice Address - Fax:870-534-7964
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-09
Last Update Date:2020-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE221242086S0129X
ARE48492086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162395001Medicaid
ARH58241Medicare UPIN
AR162395001Medicaid