Provider Demographics
NPI:1285737841
Name:STRUBLE, ROBERT A (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:STRUBLE
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 1:1221 TRIMBLE S
Mailing Address - Street 2:A-1
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44907
Mailing Address - Country:US
Mailing Address - Phone:419-756-5566
Mailing Address - Fax:419-756-2791
Practice Address - Street 1:1221 S TRIMBLE RD
Practice Address - Street 2:A-1
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44907-2200
Practice Address - Country:US
Practice Address - Phone:419-756-5566
Practice Address - Fax:419-756-2791
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2010-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35029304207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0175662Medicaid
A79451Medicare UPIN
OH0175662Medicaid