Healthcare Provider Details

I. General information

NPI: 1770675217
Provider Name (Legal Business Name): MATTHEW H LEBOEUF MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4100 STATE HIGHWAY 66
STEVENS POINT WI
54482-8410
US

IV. Provider business mailing address

6311 CONSTANCE ST
NEW ORLEANS LA
70118-5812
US

V. Phone/Fax

Practice location:
  • Phone: 715-343-7700
  • Fax:
Mailing address:
  • Phone: 832-260-8996
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number15145
License Number StateWI
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD200035
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: