Healthcare Provider Details

I. General information

NPI: 1285633552
Provider Name (Legal Business Name): LEOR DAVID ROUBEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 08/03/2021
Certification Date: 08/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1415 TULANE AVE
NEW ORLEANS LA
70112-2600
US

IV. Provider business mailing address

11104 PARKVIEW PLAZA DR SUITE 310
FORT WAYNE IN
46845
US

V. Phone/Fax

Practice location:
  • Phone: 504-988-5110
  • Fax:
Mailing address:
  • Phone: 260-266-5230
  • Fax: 260-266-5238

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number24166
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License Number26706
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD-015604
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: