Clark, Robert Kenneth
Clark, Robert Kenneth is an individual health care provider with primary practice located at 11317 S Western Ave 900, Oklahoma City OK 73170-5849. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Clark, Robert Kenneth can be contacted via phone (405) 691-8855.Contact Information
Primary practice address
11317 S Western Ave 900
Oklahoma City OK 73170-5849
Phone: (405) 691-8855
Fax: (405) 691-8891
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 13610 | Oklahoma |
Profile Details
| NPI number | 1376530600 |
|---|---|
| LBN Legal business name | Clark, Robert Kenneth |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 3rd, 2005 |
| Last updated | Jan 20th, 2010 - about 15 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1376530600 | NPPES |
| Oklahoma | MEDICAID | 100060770B |
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