Provider Demographics
NPI:1447206669
Name:LEBLANC, CHRISTEN J (MD)
Entity Type:Individual
Prefix:
First Name:CHRISTEN
Middle Name:J
Last Name:LEBLANC
Suffix:
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 1:1700 BRAZOS AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKDALE
Mailing Address - State:TX
Mailing Address - Zip Code:76567-2517
Mailing Address - Country:US
Mailing Address - Phone:512-446-4500
Mailing Address - Fax:512-446-4556
Practice Address - Street 1:1700 BRAZOS AVE.
Practice Address - Street 2:
Practice Address - City:ROCKDALE
Practice Address - State:TX
Practice Address - Zip Code:76567
Practice Address - Country:US
Practice Address - Phone:512-446-4500
Practice Address - Fax:512-446-4556
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2016-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0788207PE0004X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical Services
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX258863YK2TMedicare PIN
TX128614Medicare UPIN