Provider Demographics
NPI:1023000437
Name:LOBER, CLIFFORD W (MD)
Entity Type:Individual
Prefix:
First Name:CLIFFORD
Middle Name:W
Last Name:LOBER
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 1:505 W OAK ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-4986
Mailing Address - Country:US
Mailing Address - Phone:407-846-7166
Mailing Address - Fax:407-846-3060
Practice Address - Street 1:505 W OAK ST
Practice Address - Street 2:SUITE 201
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-4986
Practice Address - Country:US
Practice Address - Phone:407-846-7166
Practice Address - Fax:407-846-3060
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-22
Last Update Date:2008-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0031571174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
28090Medicare ID - Type Unspecified
D53476Medicare UPIN