Clark, Robert Charles

Clark, Robert Charles is an individual health care provider with primary practice located at 4370 W Main St , Dothan AL 36305. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered, which is considered as his primary health care specialty. Clark, Robert Charles can be contacted via phone (334) 793-5000.

Contact Information

Primary practice address
4370 W Main St Dothan AL 36305
Phone: (334) 793-5000
Fax: (334) 615-8428
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Nurse Anesthetist, Certified Registered 367500000X 1044483 Alabama

Profile Details

NPI number 1992766703
LBN Legal business name Clark, Robert Charles
Credentials Certified Registered Nurse Anesthetist (CRNA)
Entity Individual
Sole proprietor 1 No
Enumeration date Mar 31st, 2006
Last updated Jul 25th, 2011 - about 13 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1992766703 NPPES
Georgia MEDICAID 691173405B
Georgia MEDICAID 034384600
Georgia MEDICAID 051515739
Georgia Other 51515739
Georgia Other P00057714

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