Individual
DR. ROBERT EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1228 TOWANDA AVE STE 1, BLOOMINGTON, IL 61701-3469
(309) 454-5900
(309) 454-2820
Mailing address
1228 TOWANDA AVE STE 1, BLOOMINGTON, IL 61701-3469
(309) 454-5900
(309) 454-2820
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MT190170
PA
207RG0100X
Gastroenterology Physician
Primary
036131371
IL
207RG0100X
Gastroenterology Physician
2010017443
MO
Other
Enumeration date
07/03/2008
Last updated
06/28/2024
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