Provider Demographics
NPI:1801988076
Name:LEBLANC, JACQUES YVES (MD)
Entity type:Individual
Prefix:
First Name:JACQUES
Middle Name:YVES
Last Name:LEBLANC
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:203 S ROLLIE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LUPTON
Mailing Address - State:CO
Mailing Address - Zip Code:80621-1508
Mailing Address - Country:US
Mailing Address - Phone:970-867-0300
Mailing Address - Fax:970-867-2145
Practice Address - Street 1:729 E RAILROAD AVE
Practice Address - Street 2:
Practice Address - City:FORT MORGAN
Practice Address - State:CO
Practice Address - Zip Code:80701-3340
Practice Address - Country:US
Practice Address - Phone:970-867-0300
Practice Address - Fax:970-867-4662
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.39569207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO35658878Medicaid
CO35658878Medicaid