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General NPI Number Information
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NPI Number | 1114358744
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Entity Type | Organization
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Legal Business Name | NORTH COAST ORTHOPAEDICS
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Dates
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Enumeration Date | 12/08/2013
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Last Update Date | 12/08/2013
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Provider Practice Location Address
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Address Line | 4779 VALLEY EAST BLVD STE 1
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City | ARCATA
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State | CA
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Zip | 95521-4631
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Country | US
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Telephone | 707-499-2578
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Fax |
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Provider Business Mailing Address
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Address Line | 4779 VALLEY EAST BLVD STE 1
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City | ARCATA
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State | CA
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Zip | 95521-4631
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Country | US
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Telephone | 707-499-2578
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JOHN LEBLANC
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Credential | D.O.
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Telephone | 707-499-2578
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | 20A-9669
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License Number State | CA
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