1811166747 NPI number — DR. RICHARD LE BLANC MD PHD

Table of content: DR. RICHARD LE BLANC MD PHD (NPI 1811166747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811166747 NPI number — DR. RICHARD LE BLANC MD PHD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LE BLANC
Provider First Name:
RICHARD
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD PHD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1811166747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
818 DU MONT OWL'S HEAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERBROOKE
Provider Business Mailing Address State Name:
QUEBEC
Provider Business Mailing Address Postal Code:
J1L2Z5
Provider Business Mailing Address Country Code:
CA
Provider Business Mailing Address Telephone Number:
819-346-1110
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7400 MERTON MINTER BOULEVARD
Provider Second Line Business Practice Location Address:
SOUTH TEXAS VETERANS HEALTH CARE SYSTEM
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78284-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-617-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZH0000X , with the licence number:  4301091407 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X , with the licence number: 4301091407 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)