Provider Demographics
NPI:1760441174
Name:LUBERTO, ROBERT PHILIP (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:PHILIP
Last Name:LUBERTO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7717 W DEER VALLEY RD
Mailing Address - Street 2:SUITE 125
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382
Mailing Address - Country:US
Mailing Address - Phone:623-561-6300
Mailing Address - Fax:623-572-5400
Practice Address - Street 1:7717 W. DEER VALLEY RD.
Practice Address - Street 2:SUITE 125
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382
Practice Address - Country:US
Practice Address - Phone:623-561-6300
Practice Address - Fax:623-572-5400
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2011-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3176207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100429Medicare ID - Type UnspecifiedMEDICARE
AZF64469Medicare UPIN