Provider Demographics
NPI:1255338414
Name:LEON, ROBERT G I (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:G
Last Name:LEON
Suffix:I
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 1:4710 E WHITE DR
Mailing Address - Street 2:
Mailing Address - City:PARADISE VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85253-2416
Mailing Address - Country:US
Mailing Address - Phone:602-319-1975
Mailing Address - Fax:
Practice Address - Street 1:4710 E WHITE DR
Practice Address - Street 2:
Practice Address - City:PARADISE VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85253-2416
Practice Address - Country:US
Practice Address - Phone:602-319-1975
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-02
Last Update Date:2024-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8901207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZD37181Medicare UPIN