Healthcare Provider Details

I. General information

NPI: 1760474191
Provider Name (Legal Business Name): KIRK STEVEN LEBLANC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 02/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 W PINHOOK RD SUITE 303
LAFAYETTE LA
70503-2460
US

IV. Provider business mailing address

1000 W PINHOOK RD SUITE 303
LAFAYETTE LA
70503-2460
US

V. Phone/Fax

Practice location:
  • Phone: 337-234-8533
  • Fax: 337-234-8534
Mailing address:
  • Phone: 337-234-8533
  • Fax: 337-234-8534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number09274R
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: