Provider Demographics
NPI:1144365420
Name:ROBERT P LUBERTO DO PC
Entity type:Organization
Organization Name:ROBERT P LUBERTO DO PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:PHILIP
Authorized Official - Last Name:LUBERTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:623-561-6300
Mailing Address - Street 1:7717 W DEER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85382-2102
Mailing Address - Country:US
Mailing Address - Phone:623-561-6300
Mailing Address - Fax:623-572-5400
Practice Address - Street 1:7717 W DEER VALLEY RD
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85382-2102
Practice Address - Country:US
Practice Address - Phone:623-561-6300
Practice Address - Fax:623-572-5400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-21
Last Update Date:2010-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ100428Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER