Healthcare Provider Details

I. General information

NPI: 1144724378
Provider Name (Legal Business Name): LOGAN LEBLANC ST. CYR MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2018
Last Update Date: 03/14/2024
Certification Date: 03/14/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8120 MAIN ST STE 304
HOUMA LA
70360-3403
US

IV. Provider business mailing address

5246 BRITTANY DR
BATON ROUGE LA
70808-9136
US

V. Phone/Fax

Practice location:
  • Phone: 985-873-3484
  • Fax:
Mailing address:
  • Phone: 225-757-4300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number325710
License Number StateLA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number325710
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: