Individual
DR. CHARLES J GBUR JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5705 MONCLOVA RD, SUITE 201, MAUMEE, OH 43537-1875
(419) 794-7700
(419) 794-7715
Mailing address
725 S SHOOP AVE, WAUSEON, OH 43567-1702
(419) 893-7700
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
35055676G
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000476150
ANTHEM
OH
01
—
01714
PARAMOUNT
OH
05
—
0671705
—
OH
01
—
4397998
AETNA
OH
05
—
4951357
—
MI
05
—
4951375
—
MI
05
—
4951384
—
MI
01
—
611448753031
CARESOURCE
OH
01
—
P00334723
RRMC
OH
Enumeration date
06/01/2005
Last updated
05/31/2023
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