MEDICARE: DR. ROBERTO LEBRON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	35085944	OH
2	207Q00000X	Family Medicine Physician	13204	PR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1871553198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERTO LEBRON M.D.

Provider Business Mailing Address
First Line	:	525 E MARKET ST
Second Line	:	PO BOX 2090
City	:	AKRON
State	:	OH
Zip	:	44304-1619
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1069 KENMORE BLVD
Second Line	:
City	:	AKRON
State	:	OH
Zip	:	44314-2157
Country	:	US
Telephone Number	:	330-848-0670
Fax Number	:	330-848-0672

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/23/2006
Last Update Date	:	07/06/2011

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