Provider Demographics
NPI:1942390794
Name:LOOBY, ROBERT G (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:G
Last Name:LOOBY
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 1:124 WALNUT AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIRSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43950-1702
Mailing Address - Country:US
Mailing Address - Phone:740-695-6336
Mailing Address - Fax:
Practice Address - Street 1:951 E MARKET ST
Practice Address - Street 2:
Practice Address - City:CADIZ
Practice Address - State:OH
Practice Address - Zip Code:43907-9799
Practice Address - Country:US
Practice Address - Phone:740-942-6216
Practice Address - Fax:740-942-6218
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35048646207Q00000X
NJ25MA02890500207Q00000X
WV13410207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0554261Medicaid
OHA72824Medicare ID - Type Unspecified
A72824Medicare UPIN