Provider Demographics
NPI:1760461685
Name:ROBB, LEO JOSEPH III (DO)
Entity Type:Individual
Prefix:
First Name:LEO
Middle Name:JOSEPH
Last Name:ROBB
Suffix:III
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14201 W SUNRISE BLVD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:SUNRISE
Mailing Address - State:FL
Mailing Address - Zip Code:33323-3207
Mailing Address - Country:US
Mailing Address - Phone:954-505-5000
Mailing Address - Fax:
Practice Address - Street 1:2015 OCEAN DR STE 11
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33426-5131
Practice Address - Country:US
Practice Address - Phone:561-364-8056
Practice Address - Fax:561-364-8507
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS12617207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013038450005Medicaid
PA0019858OtherAETNA HMO
PA4101101OtherAETNA
PA1675618OtherCIGNA
PA0080293000OtherBCBS
PA2157839OtherMAMSI
PA30028886OtherKEYSTONE MERCY
PA611816802OtherUS DEPARTMENT OF LABOR
PA0110557OtherBCBS
C30411Medicare UPIN
PA110557VGUMedicare PIN
PA1675618OtherCIGNA