Provider Demographics
NPI:1457344129
Name:LEBBY, ROBERT A (MD)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:A
Last Name:LEBBY
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 1:1216 BERMUDA DR
Mailing Address - Street 2:
Mailing Address - City:LAGUNA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92651-1904
Mailing Address - Country:US
Mailing Address - Phone:949-338-4799
Mailing Address - Fax:949-497-2467
Practice Address - Street 1:11 MAREBLU STE 200
Practice Address - Street 2:
Practice Address - City:ALISO VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92656-3044
Practice Address - Country:US
Practice Address - Phone:949-446-8990
Practice Address - Fax:949-446-8535
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-26
Last Update Date:2020-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG69980207RP1001X, 207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep Medicine
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G699800Medicaid
CA00G699800Medicaid
F84403Medicare UPIN