Provider Demographics
NPI:1881694305
Name:GUIBORD, ROBERTA J (DO)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:J
Last Name:GUIBORD
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 W S BOUNDARY ST
Mailing Address - Street 2:BUILDING 3B
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5230
Mailing Address - Country:US
Mailing Address - Phone:419-872-5556
Mailing Address - Fax:419-872-5559
Practice Address - Street 1:900 W S BOUNDARY ST
Practice Address - Street 2:BUILDING 3B
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5230
Practice Address - Country:US
Practice Address - Phone:419-872-5556
Practice Address - Fax:419-872-5559
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH5868207Q00000X
OH34.005868207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0995839Medicaid
OH930122301OtherRAILROAD MEDICARE
OHRO9364491OtherMEDICARE ID # GROUP
OH000000271434OtherANTHEM
OH810547599067OtherCARESOURCE
MI4436166Medicaid
OHGU4090794OtherMEDICARE ID # INDIVIDUAL
MI4436166Medicaid
OH930122301OtherRAILROAD MEDICARE