Basic Information
| Provider Information | |||||||||
| NPI: | 1063586576 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LE BLANC | ||||||||
| FirstName: | YVES | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 52D MEDICAL GROUP | ||||||||
| Address2: | UNIT 3690 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3134528755 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 52D MEDICAL GROUP | ||||||||
| Address2: | UNIT 3690 | ||||||||
| City: | APO | ||||||||
| State: | AE | ||||||||
| PostalCode: | 09126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144528755 | ||||||||
| FaxNumber: | 3139163235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 02/22/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/11/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 4301074418 | MI | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.