Provider Demographics
NPI:1316046493
Name:YOUNGBLOOD, LEAH C (MD)
Entity type:Individual
Prefix:MRS
First Name:LEAH
Middle Name:C
Last Name:YOUNGBLOOD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MS
Other - First Name:LEAH
Other - Middle Name:C
Other - Last Name:ANNULIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:9600 BAPTIST HEALTH DR
Mailing Address - Street 2:SUITE 360
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72205-6326
Mailing Address - Country:US
Mailing Address - Phone:501-227-6727
Mailing Address - Fax:501-223-9462
Practice Address - Street 1:9600 BAPTIST HEALTH DR
Practice Address - Street 2:SUITE 360
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-6326
Practice Address - Country:US
Practice Address - Phone:501-227-6727
Practice Address - Fax:501-223-9462
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2011-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-4818208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARE4818OtherTRICARE
AR06070014900OtherQUALCHOICE
AR162734001Medicaid
ARI65416Medicare UPIN
AR06070014900OtherQUALCHOICE