Healthcare Provider Details

I. General information

NPI: 1184626483
Provider Name (Legal Business Name): CHARLES J GBUR JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

IV. Provider business mailing address

725 S SHOOP AVE
WAUSEON OH
43567-1702
US

V. Phone/Fax

Practice location:
  • Phone: 419-330-2653
  • Fax: 419-330-2656
Mailing address:
  • Phone: 419-330-2653
  • Fax: 419-330-2656

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number35055676G
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: