Individual
DR. MAVERICK JOSEPH LEBLANC
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2601 E ROOSEVELT ST, PHOENIX, AZ 85008-4973
(602) 344-1516
(602) 344-1004
Mailing address
2929 E THOMAS RD, PHOENIX, AZ 85016-8034
(602) 470-5560
(602) 470-5064
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
2017043788
MO
2085R0202X
Diagnostic Radiology Physician
322598
LA
2085R0202X
Diagnostic Radiology Physician
Primary
66556
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
ENROLLED
—
IL
Enumeration date
04/14/2014
Last updated
08/15/2022
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