Provider Demographics
NPI:1477769313
Name:LEBLANC, DORIS ELIZABETH (MD)
Entity Type:Individual
Prefix:MS
First Name:DORIS
Middle Name:ELIZABETH
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DORIS
Other - Middle Name:ELIZABETH
Other - Last Name:LEBLANC JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:800 FULTON ST
Mailing Address - Street 2:ATTN: ANNE LAWSON
Mailing Address - City:LOGANSPORT
Mailing Address - State:IN
Mailing Address - Zip Code:46947-1577
Mailing Address - Country:US
Mailing Address - Phone:574-205-2600
Mailing Address - Fax:574-739-1414
Practice Address - Street 1:1015 MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:LOGANSPORT
Practice Address - State:IN
Practice Address - Zip Code:46947-1526
Practice Address - Country:US
Practice Address - Phone:574-722-5151
Practice Address - Fax:574-739-1414
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA152922084P0800X
IN01072052A2084P0800X
CODR.00553342084P0800X
VT042.00128262084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201148880Medicaid