Provider Demographics
NPI:1003823063
Name:LEVERENCE, ROBERT RICHARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:RICHARD
Last Name:LEVERENCE
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 1:7703 FLOYD CURL DR # MC7977
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229-3901
Mailing Address - Country:US
Mailing Address - Phone:210-450-9000
Mailing Address - Fax:210-450-6009
Practice Address - Street 1:8300 FLOYD CURL DR FL 1
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78229
Practice Address - Country:US
Practice Address - Phone:210-450-9100
Practice Address - Fax:210-450-6009
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2018-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM97-304207R00000X
FLME110070207R00000X
TXR7518208M00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL003727200Medicaid
TX385469702OtherCSHCN
TX385469701Medicaid