Healthcare Provider Details

I. General information

NPI: 1518941145
Provider Name (Legal Business Name): ROBERT J LOBONC M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/06/2005
Last Update Date: 11/03/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4704 MEXICO RD
SAINT PETERS MO
63376-1663
US

IV. Provider business mailing address

4704 MEXICO RD
SAINT PETERS MO
63376-1663
US

V. Phone/Fax

Practice location:
  • Phone: 636-441-4144
  • Fax: 636-441-4112
Mailing address:
  • Phone: 636-441-4144
  • Fax: 636-441-4112

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberR7C25
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: