Basic Information
| Provider Information | |||||||||
| NPI: | 1760461685 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ROBB | ||||||||
| FirstName: | LEO | ||||||||
| MiddleName: | JOSEPH | ||||||||
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| NameSuffix: | III | ||||||||
| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 14201 W SUNRISE BLVD | ||||||||
| Address2: | SUITE 207 | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333233207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9545055000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2015 OCEAN DR STE 11 | ||||||||
| Address2: | |||||||||
| City: | BOYNTON BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334265131 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613648056 | ||||||||
| FaxNumber: | 5613648507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/10/2006 | ||||||||
| LastUpdateDate: | 02/21/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | OS12617 | FL | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0080293000 | 01 | PA | BCBS | OTHER | 0110557 | 01 | PA | BCBS | OTHER | 30028886 | 01 | PA | KEYSTONE MERCY | OTHER | 4101101 | 01 | PA | AETNA | OTHER | 611816802 | 01 | PA | US DEPARTMENT OF LABOR | OTHER | 0019858 | 01 | PA | AETNA HMO | OTHER | 2157839 | 01 | PA | MAMSI | OTHER | 1675618 | 01 | PA | CIGNA | OTHER | 0013038450005 | 05 | PA | MEDICAID |