Provider Demographics
NPI:1205875853
Name:LEBLANC, CHRISTOPHER W (DO)
Entity type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:W
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 PLANTATION PARK DR
Mailing Address - Street 2:STE 401B
Mailing Address - City:BLUFFTON
Mailing Address - State:SC
Mailing Address - Zip Code:29910-6094
Mailing Address - Country:US
Mailing Address - Phone:843-422-4413
Mailing Address - Fax:
Practice Address - Street 1:23 PLANTATION PARK DR
Practice Address - Street 2:STE 401B
Practice Address - City:BLUFFTON
Practice Address - State:SC
Practice Address - Zip Code:29910-6094
Practice Address - Country:US
Practice Address - Phone:843-815-5566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCTL985207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCP01163665OtherRAILROAD MEDICARE
SCE499OtherGROUP MEDICARE PTAN
SCGP6817OtherMEDICAID GROUP LEGACY
SCP01163665OtherRAILROAD MEDICARE
SCP01163665OtherRAILROAD MEDICARE
SCTL9855Medicaid