Clark, Robert E

Clark, Robert E is an individual health care provider with primary practice located at 1600 22Nd Ave Medical Towers Iii, Meridian MS 39301-3223. He recently has only one registered license in Allopathic & Osteopathic Physicians / Nephrology, which is considered as his primary health care specialty. Clark, Robert E can be contacted via phone (601) 483-5322.

Contact Information

Primary practice address
1600 22Nd Ave Medical Towers Iii Meridian MS 39301-3223
Phone: (601) 483-5322
Fax: (601) 693-8081
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Nephrology 207RN0300X 07973 Mississippi

Profile Details

NPI number 1518944198
LBN Legal business name Clark, Robert E
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 27th, 2005
Last updated Jun 2nd, 2011 - about 14 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 1518944198 NPPES
Mississippi MEDICAID 00116455

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