Provider Demographics
NPI:1740479104
Name:CIBIRAS, ROBERT ALLAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALLAN
Last Name:CIBIRAS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11740 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:BLAKELY
Mailing Address - State:GA
Mailing Address - Zip Code:39823-2574
Mailing Address - Country:US
Mailing Address - Phone:229-724-4282
Mailing Address - Fax:229-724-4283
Practice Address - Street 1:11740 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:BLAKELY
Practice Address - State:GA
Practice Address - Zip Code:39823-2574
Practice Address - Country:US
Practice Address - Phone:229-724-4282
Practice Address - Fax:229-724-4283
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-22
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9101120363AM0700X
AZ3801363AM0700X
ALPA251363AM0700X
GA007212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
Z120162Medicare UPIN