Provider Demographics
NPI:1285633552
Name:ROUBEIN, LEOR DAVID (MD)
Entity Type:Individual
Prefix:MR
First Name:LEOR
Middle Name:DAVID
Last Name:ROUBEIN
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 1:11104 PARKVIEW PLAZA DR SUITE 310
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845
Mailing Address - Country:US
Mailing Address - Phone:260-266-5230
Mailing Address - Fax:260-266-5238
Practice Address - Street 1:1415 TULANE AVE
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70112-2600
Practice Address - Country:US
Practice Address - Phone:504-988-5110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK24166207RG0100X
NY26706207RG0100X
LAMD-015604207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1552097Medicaid
MS08354891Medicaid
OK200036030AMedicaid
LA4M4196629Medicare PIN
LA4M419Medicare PIN
LA1552097Medicaid
C21353Medicare UPIN