Provider Demographics
NPI:1700879657
Name:OBRI, SAMER S (MD)
Entity Type:Individual
Prefix:
First Name:SAMER
Middle Name:S
Last Name:OBRI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1250 RALSTON AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:DEFIANCE
Mailing Address - State:OH
Mailing Address - Zip Code:43512-5311
Mailing Address - Country:US
Mailing Address - Phone:419-784-2776
Mailing Address - Fax:419-782-6899
Practice Address - Street 1:1250 RALSTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:DEFIANCE
Practice Address - State:OH
Practice Address - Zip Code:43512-5311
Practice Address - Country:US
Practice Address - Phone:419-784-2776
Practice Address - Fax:419-782-6899
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2023-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35079420207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH7744282OtherAETNA
OH000000195120OtherANTHEM
OH110224866OtherRRMC
OH2234237Medicaid
OH03962OtherPHC
OH04-06926OtherUHC
OH04-06926OtherUHC