Provider Demographics
NPI:1558540690
Name:LEBLANC, ALLEN JAMES JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
Middle Name:JAMES
Last Name:LEBLANC
Suffix:JR
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 1:3807 PRESCOTT RD
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71301-3732
Mailing Address - Country:US
Mailing Address - Phone:318-561-6774
Mailing Address - Fax:318-561-6764
Practice Address - Street 1:3807 PRESCOTT RD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71301-3732
Practice Address - Country:US
Practice Address - Phone:318-561-6774
Practice Address - Fax:318-561-6764
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA14403R174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1112232Medicaid
LA1112232Medicaid