Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | MD.206923 | LA |
NPI | 1013235647 |
---|---|
Provider Name | Jessica Leblanc |
First Address | Baton Rouge, LA 70808-4373 |
Second Address | Zachary, LA 70791-4090 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/05/2010 |
Last Update Date | 14/01/2020 |