Provider Demographics
NPI:1669509758
Name:LEBLANC, JOSEPH VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:VINCENT
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 1:1315 SE QUAIL DR
Mailing Address - Street 2:
Mailing Address - City:BARTLESVILLE
Mailing Address - State:OK
Mailing Address - Zip Code:74006-4335
Mailing Address - Country:US
Mailing Address - Phone:918-333-0136
Mailing Address - Fax:
Practice Address - Street 1:1315 SE QUAIL DR
Practice Address - Street 2:
Practice Address - City:BARTLESVILLE
Practice Address - State:OK
Practice Address - Zip Code:74006-4335
Practice Address - Country:US
Practice Address - Phone:918-333-0136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10328207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF59435Medicare UPIN