Provider Demographics
NPI:1184601031
Name:LEY, ROBERT EARL III (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:EARL
Last Name:LEY
Suffix:III
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 1:420 REEVES AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:DOVER
Mailing Address - State:OH
Mailing Address - Zip Code:44622-2162
Mailing Address - Country:US
Mailing Address - Phone:330-364-7791
Mailing Address - Fax:330-343-5066
Practice Address - Street 1:420 REEVES AVE
Practice Address - Street 2:SUITE C
Practice Address - City:DOVER
Practice Address - State:OH
Practice Address - Zip Code:44622-2162
Practice Address - Country:US
Practice Address - Phone:330-364-7791
Practice Address - Fax:330-343-5066
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-30
Last Update Date:2009-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34034701L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0303540Medicaid
OH0303540Medicaid
LE0423752Medicare ID - Type Unspecified