Individual
BLAKE MICHAEL LEBLANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1190 N STATE ST STE 403, JACKSON, MS 39202-2413
(769) 268-6770
(769) 268-6769
Mailing address
350 N HUMPHREYS BLVD, MEMPHIS, TN 38120-2177
(901) 226-4003
(901) 227-8591
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
33165
MS
390200000X
Student in an Organized Health Care Education/Training Program
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Other
Enumeration date
03/26/2021
Last updated
08/12/2025
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