Individual
ROBERT EDWARD CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1141 ROSE AVE, SELMA, CA 93662-3241
(559) 891-6337
Mailing address
PO BOX 780, HANFORD, CA 93232-0780
(415) 272-3517
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
C29418
CA
2085R0202X
Diagnostic Radiology Physician
Primary
C29418
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00C294180
—
CA
01
—
300062393
RAILROAD MEDICARE PIN
—
Enumeration date
05/05/2006
Last updated
06/10/2011
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