Provider Demographics
NPI:1801468608
Name:SEIBERLICH, ROBERT (NMD, LMT)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:
Last Name:SEIBERLICH
Suffix:
Gender:
Credentials:NMD, LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:550 LARKSPUR ST APT B203
Mailing Address - Street 2:
Mailing Address - City:PONDERAY
Mailing Address - State:ID
Mailing Address - Zip Code:83852-5018
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:550 LARKSPUR ST APT B203
Practice Address - Street 2:
Practice Address - City:PONDERAY
Practice Address - State:ID
Practice Address - Zip Code:83852-5018
Practice Address - Country:US
Practice Address - Phone:360-801-4888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-13
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
IDNMD-0036208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No175F00000XOther Service ProvidersNaturopath