Provider Demographics
NPI:1932142478
Name:LEFEVER, LEROY (DO)
Entity Type:Individual
Prefix:
First Name:LEROY
Middle Name:
Last Name:LEFEVER
Suffix:
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 1:3913 DARROW RD
Mailing Address - Street 2:
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-2621
Mailing Address - Country:US
Mailing Address - Phone:330-971-7405
Mailing Address - Fax:330-971-7343
Practice Address - Street 1:3913 DARROW RD
Practice Address - Street 2:
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-2621
Practice Address - Country:US
Practice Address - Phone:330-971-7405
Practice Address - Fax:330-971-7343
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-001841207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0178294Medicaid
OH0178294Medicaid
0015707Medicare PIN