Provider Demographics
NPI:1295507788
Name:LEBLANC, RENE III (CAPRC I)
Entity type:Individual
Prefix:MR
First Name:RENE
Middle Name:
Last Name:LEBLANC
Suffix:III
Gender:M
Credentials:CAPRC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 222
Mailing Address - Street 2:
Mailing Address - City:BERNE
Mailing Address - State:IN
Mailing Address - Zip Code:46711-0222
Mailing Address - Country:US
Mailing Address - Phone:260-301-4501
Mailing Address - Fax:
Practice Address - Street 1:5655 S 400 W
Practice Address - Street 2:
Practice Address - City:BERNE
Practice Address - State:IN
Practice Address - Zip Code:46711-9519
Practice Address - Country:US
Practice Address - Phone:260-301-4501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-10-27
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INCAPRC1-5822175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist