Healthcare Provider Details

I. General information

NPI: 1164408787
Provider Name (Legal Business Name): CHERI LEBLANC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2005
Last Update Date: 07/27/2024
Certification Date: 07/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15165 S HARRELLS FERRY RD
BATON ROUGE LA
70816-2910
US

IV. Provider business mailing address

15165 S HARRELLS FERRY RD
BATON ROUGE LA
70816-2910
US

V. Phone/Fax

Practice location:
  • Phone: 225-756-5305
  • Fax:
Mailing address:
  • Phone: 225-756-5305
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number11032R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: