Provider Demographics
NPI:1972765493
Name:LEBLANC, KEITH GERARD JR (MD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:GERARD
Last Name:LEBLANC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1615 METAIRIE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70005-3974
Mailing Address - Country:US
Mailing Address - Phone:504-644-4226
Mailing Address - Fax:504-208-1135
Practice Address - Street 1:1615 METAIRIE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70005-3974
Practice Address - Country:US
Practice Address - Phone:504-644-4226
Practice Address - Fax:504-208-1135
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2013-11-12
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Provider Licenses
StateLicense IDTaxonomies
ALMD31526207N00000X
LAMD.206061207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology