Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 1862 | NE |
N | 208D00000X | General Practice Physician | 1862 | NE |
NPI | 1033643481 |
---|---|
Provider Name | Zachary J Leblanc |
First Address | Jbsa Ft Sam Houston, TX 78234-4504 |
Second Address | San Antonio, TX 78234-4504 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/04/2017 |
Last Update Date | 30/07/2021 |