Provider Demographics
NPI:1588031942
Name:SHIBUYA, ROBERT BARNET (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:BARNET
Last Name:SHIBUYA
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 1:1772 JOHNSON RD NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30306-3147
Mailing Address - Country:US
Mailing Address - Phone:301-801-2560
Mailing Address - Fax:
Practice Address - Street 1:1772 JOHNSON RD NE
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30306-3147
Practice Address - Country:US
Practice Address - Phone:301-801-2560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-01
Last Update Date:2015-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG77898207ZP0101X
MDD0059010207ZP0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0101XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology