Provider Demographics
NPI:1396705497
Name:LEBLANC, BRYCE JOSEPH JR (MD)
Entity type:Individual
Prefix:DR
First Name:BRYCE
Middle Name:JOSEPH
Last Name:LEBLANC
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3901 HOUMA BLVD
Mailing Address - Street 2:STE 500
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70006-2927
Mailing Address - Country:US
Mailing Address - Phone:504-454-1080
Mailing Address - Fax:504-455-4463
Practice Address - Street 1:3901 HOUMA BLVD
Practice Address - Street 2:STE 500
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70006-2927
Practice Address - Country:US
Practice Address - Phone:504-454-1080
Practice Address - Fax:504-455-4463
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-24
Last Update Date:2017-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA016232207YP0228X, 207YX0602X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YP0228XAllopathic & Osteopathic PhysiciansOtolaryngologyPediatric Otolaryngology
Not Answered207YX0602XAllopathic & Osteopathic PhysiciansOtolaryngologyOtolaryngic Allergy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA0690028OtherAETNA
LA40417OtherBLUE CROSS
LA1357952Medicaid
LAB62907Medicare UPIN
LA1357952Medicaid