Provider Demographics
NPI:1831182765
Name:MCBRIDE, ROBERT BRIAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRIAN
Last Name:MCBRIDE
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 1:113 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-3301
Mailing Address - Country:US
Mailing Address - Phone:219-873-3130
Mailing Address - Fax:219-873-3132
Practice Address - Street 1:814 LAPORTE AVE
Practice Address - Street 2:PORTER MEMORIAL HOSPITAL
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46383-5860
Practice Address - Country:US
Practice Address - Phone:219-465-4678
Practice Address - Fax:219-465-4722
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041300A207ZP0102X
IL207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN5392576002OtherCIGNA
IN83421OtherBC/BS
IN482210PMedicare UPIN
IN652630LMedicare PIN
G25137Medicare UPIN