Provider Demographics
NPI:1184626483
Name:GBUR, CHARLES J JR (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:J
Last Name:GBUR
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:725 S SHOOP AVE
Mailing Address - Street 2:
Mailing Address - City:WAUSEON
Mailing Address - State:OH
Mailing Address - Zip Code:43567-1702
Mailing Address - Country:US
Mailing Address - Phone:419-893-7700
Mailing Address - Fax:
Practice Address - Street 1:5705 MONCLOVA RD
Practice Address - Street 2:SUITE 201
Practice Address - City:MAUMEE
Practice Address - State:OH
Practice Address - Zip Code:43537-1875
Practice Address - Country:US
Practice Address - Phone:419-794-7700
Practice Address - Fax:419-794-7715
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35055676G207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH4397998OtherAETNA
MI4951384Medicaid
OH01714OtherPARAMOUNT
OH611448753031OtherCARESOURCE
MI4951375Medicaid
OH0671705Medicaid
MI4951357Medicaid
OH000000476150OtherANTHEM
OHP00334723OtherRRMC
OH0671705Medicaid