Healthcare Provider Details

I. General information

NPI: 1699273292
Provider Name (Legal Business Name): LEON LAPLEAU MCINTIRE SR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/29/2018
Last Update Date: 01/29/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 E 3RD ST
CROWLEY LA
70526-5308
US

IV. Provider business mailing address

PO BOX 173
FORTSON GA
31808-0173
US

V. Phone/Fax

Practice location:
  • Phone: 706-761-5751
  • Fax:
Mailing address:
  • Phone: 706-571-3544
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.008638
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberMD.008638
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: