Individual
DR. ROBERT TIMOTHY MABRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2501 KENTUCKY AVE, PADUCAH, KY 42003-3813
(270) 744-9600
(270) 744-0834
Mailing address
PO BOX 9150, PADUCAH, KY 42002-9150
(270) 744-9600
(270) 744-0834
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
33994
KY
207R00000X
Internal Medicine Physician
33994
KY
208000000X
Pediatrics Physician
33994
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
64035553
—
KY
Enumeration date
05/24/2005
Last updated
06/07/2013
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