Basic Information
| Provider Information | |||||||||
| NPI: | 1003823063 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LEVERENCE | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | RICHARD | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7703 FLOYD CURL DR # MC7977 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782293901 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104509000 | ||||||||
| FaxNumber: | 2104506009 | ||||||||
| Practice Location | |||||||||
| Address1: | 8300 FLOYD CURL DR FL 1 | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2104509100 | ||||||||
| FaxNumber: | 2104506009 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/02/2006 | ||||||||
| LastUpdateDate: | 08/07/2018 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 97-304 | NM | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207R00000X | ME110070 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | 208M00000X | R7518 | TX | N | Allopathic & Osteopathic Physicians | Hospitalist | 207R00000X | R7518 | TX | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 003727200 | 05 | FL | MEDICAID | 385469702 | 01 | TX | CSHCN | OTHER | 385469701 | 05 | TX | MEDICAID |