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Individual
ROBERT BROOKS CLARKE
Active
Individual
ROBERT BROOKS CLARKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA01650
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200344401
—
TX
01
—
TIN PLUS 001
TRICARE CANTON LOCATION
TX
01
—
TIN PLUS 007
TRICARE DOUGLAS LOCATION
TX
01
—
TIN PLUS 028
TRICARE LINDALE LOCATION
TX
Enumeration date
03/15/2007
Last updated
10/10/2014
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