Provider Demographics
NPI:1932209855
Name:LAVEY, ROBERT S (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:LAVEY
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 1:1221 S BROADWAY
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40504-2701
Mailing Address - Country:US
Mailing Address - Phone:859-258-6200
Mailing Address - Fax:859-258-6203
Practice Address - Street 1:1401 HARRODSBURG RD STE A100
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40504-3746
Practice Address - Country:US
Practice Address - Phone:859-258-6700
Practice Address - Fax:859-258-6509
Is Sole Proprietor?:No
Enumeration Date:2006-09-22
Last Update Date:2022-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN559432085R0001X
FLME1017402085R0001X
CAG502702085R0001X
OH35.1229462085R0001X
KYC07942085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL000184900Medicaid
OH0098905Medicaid
CA00G502700Medicaid
CA00G502700 F85OtherCAL OPTIMA
CA00G502700Medicaid
FL000184900Medicaid
OHH280300Medicare PIN
FLAO786ZMedicare PIN