Healthcare Provider Details

I. General information

NPI: 1538243704
Provider Name (Legal Business Name): ROBERTA JUNE GUIBORD, D.O., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 W SOUTH BOUNDARY ST SUITE 3-B
PERRYSBURG OH
43551-5230
US

IV. Provider business mailing address

900 W SOUTH BOUNDARY ST SUITE 3-B
PERRYSBURG OH
43551-5230
US

V. Phone/Fax

Practice location:
  • Phone: 419-872-5556
  • Fax: 419-872-5559
Mailing address:
  • Phone: 419-872-5556
  • Fax: 419-872-5559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34-005868-G
License Number StateOH

VIII. Authorized Official

Name: ROBERTA J. GUIBORD
Title or Position: OWNER, CEO
Credential: M.D.
Phone: 419-872-5556