MEDICARE: JOHN LEBLANC D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	DO3066	ME
2	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	DO3066	ME

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DO3066	OTHER	ME	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1750367066
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN LEBLANC D.O.

Provider Business Mailing Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	194 E MAIN ST
Second Line	:
City	:	FORT KENT
State	:	ME
Zip	:	04743-1428
Country	:	US
Telephone Number	:	207-834-1329
Fax Number	:	207-834-2949

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/19/2005
Last Update Date	:	08/13/2020

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Directions to “ JOHN LEBLANC D.O.” Practice Location

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