Provider Demographics
NPI:1346312030
Name:LEY, ROBERT D (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:D
Last Name:LEY
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 1:285 LUPINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-9749
Mailing Address - Country:US
Mailing Address - Phone:831-688-8268
Mailing Address - Fax:831-688-2485
Practice Address - Street 1:285 LUPINE VALLEY RD
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-9749
Practice Address - Country:US
Practice Address - Phone:831-688-8268
Practice Address - Fax:831-688-2485
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-15
Last Update Date:2009-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA00G330750208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00643018OtherRAILROAD MEDICARE
CA00G330750Medicaid
CA00G330750OtherBLUE SHIELD PROV ID
CA00G330750Medicare ID - Type Unspecified
CA00G330750Medicare PIN