Provider Demographics
NPI:1306982277
Name:CLEVELAND, ROBERT LYLE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LYLE
Last Name:CLEVELAND
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 1:16874 HWY. 43
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:LA
Mailing Address - Zip Code:70441-0337
Mailing Address - Country:US
Mailing Address - Phone:225-222-6111
Mailing Address - Fax:225-222-6426
Practice Address - Street 1:16874 LA. HWY. 43
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:LA
Practice Address - Zip Code:70441-0337
Practice Address - Country:US
Practice Address - Phone:225-222-6111
Practice Address - Fax:225-222-6426
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020565207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1394050Medicaid
LAE25183Medicare UPIN
LA5K886Medicare ID - Type Unspecified