Provider Demographics
NPI:1386515096
Name:LOBER, KEVIN MATTHEW
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:MATTHEW
Last Name:LOBER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5868 E 22ND PL
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74114-2320
Mailing Address - Country:US
Mailing Address - Phone:732-694-9610
Mailing Address - Fax:
Practice Address - Street 1:5868 E 22ND PL
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-2320
Practice Address - Country:US
Practice Address - Phone:732-694-9610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-09-16
Last Update Date:2025-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist