Healthcare Provider Details

I. General information

NPI: 1871102756
Provider Name (Legal Business Name): BENJAMIN JOSEPH LEBLANC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2020
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 W 15TH ST
PLANO TX
75075
US

IV. Provider business mailing address

3901 W 15TH ST
PLANO TX
75075-7738
US

V. Phone/Fax

Practice location:
  • Phone: 972-519-1186
  • Fax:
Mailing address:
  • Phone: 972-519-1186
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberW8366
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: