Individual
DR. ROBERT EDWIN EXTEN JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
803 W MARKET ST STE 200, LIMA, OH 45805-2796
(419) 222-3737
(419) 229-3234
Mailing address
475 LEXINGTON AVE, MANSFIELD, OH 44907-1501
(419) 756-2003
(419) 756-3637
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
35.038459
OH
207RH0003X
Hematology & Oncology Physician
35038459E
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000142119
ANTHEM
OH
05
—
0519460
—
OH
01
—
830006430
MEDICARE RAILRROAD
OH
Enumeration date
06/23/2005
Last updated
08/21/2023
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