Provider Demographics
NPI:1881446052
Name:LEBLANC, MALLORY ANNE (MD)
Entity type:Individual
Prefix:DR
First Name:MALLORY
Middle Name:ANNE
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1707 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32609-3650
Mailing Address - Country:US
Mailing Address - Phone:352-265-9592
Mailing Address - Fax:352-265-9584
Practice Address - Street 1:1700 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32609-3649
Practice Address - Country:US
Practice Address - Phone:352-265-9592
Practice Address - Fax:352-265-9584
Is Sole Proprietor?:No
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program