Provider Demographics
NPI:1841253192
Name:LEIBOWITZ, ROBERT LEROY (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LEROY
Last Name:LEIBOWITZ
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:STE 1005
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067
Mailing Address - Country:US
Mailing Address - Phone:310-229-3555
Mailing Address - Fax:310-229-3554
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:STE 1005
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067
Practice Address - Country:US
Practice Address - Phone:310-229-3555
Practice Address - Fax:310-229-3554
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-08
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG2R905207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A43905Medicare UPIN
W7145Medicare ID - Type Unspecified