Provider Demographics
NPI:1811166747
Name:LE BLANC, RICHARD (MD PHD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:LE BLANC
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:818 DU MONT OWL'S HEAD
Mailing Address - Street 2:
Mailing Address - City:SHERBROOKE
Mailing Address - State:QUEBEC
Mailing Address - Zip Code:J1L2Z5
Mailing Address - Country:CA
Mailing Address - Phone:819-346-1110
Mailing Address - Fax:
Practice Address - Street 1:7400 MERTON MINTER BOULEVARD
Practice Address - Street 2:SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78284-5100
Practice Address - Country:US
Practice Address - Phone:210-617-5300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-02-25
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301091407207ZH0000X, 207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207ZH0000XAllopathic & Osteopathic PhysiciansPathologyHematology