Provider Demographics
NPI:1124046263
Name:LEABER, ROBERT J III
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:LEABER
Suffix:III
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 HIGHWAY 311
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2865
Mailing Address - Country:US
Mailing Address - Phone:985-580-4688
Mailing Address - Fax:985-580-4851
Practice Address - Street 1:4730 HIGHWAY 311
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2865
Practice Address - Country:US
Practice Address - Phone:985-580-4688
Practice Address - Fax:985-580-4851
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1744P3200XOther Service ProvidersSpecialistProsthetics Case Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1545392Medicaid
LA1545392Medicaid