Provider Demographics
NPI:1922147818
Name:DAIBER, ROBERT RAYMOND (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:RAYMOND
Last Name:DAIBER
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 1:3240 GODDARD RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43606-1828
Mailing Address - Country:US
Mailing Address - Phone:419-276-1628
Mailing Address - Fax:
Practice Address - Street 1:118 E INDIANA AVE
Practice Address - Street 2:
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-2826
Practice Address - Country:US
Practice Address - Phone:419-794-3026
Practice Address - Fax:419-794-3006
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301075438207Q00000X
OH35-064194207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1922147818OtherMERCY PHO
MI1922147818OtherHUMANA
MI1922147818OtherMERCY PHO
OH1922147818OtherHUMANA
OH0971088Medicaid
MIP04110003Medicare PIN
OH4281742Medicare PIN
OH1922147818OtherMERCY PHO
MI1922147818OtherMERCY PHO
MI1922147818OtherHUMANA
OHF77861Medicare UPIN