Provider Demographics
NPI:1871553198
Name:LEBRON, ROBERTO (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:
Last Name:LEBRON
Suffix:
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 1:525 E MARKET ST
Mailing Address - Street 2:PO BOX 2090
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44304-1619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1069 KENMORE BLVD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44314-2157
Practice Address - Country:US
Practice Address - Phone:330-848-0670
Practice Address - Fax:330-848-0672
Is Sole Proprietor?:No
Enumeration Date:2006-03-23
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35085944207Q00000X
PR13204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2569019Medicaid
OH4161574Medicare PIN
OHH82861Medicare UPIN