Individual
ROBERT CHARLES CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
4370 W MAIN ST, DOTHAN, AL 36305
(334) 793-5000
(334) 615-8428
Mailing address
PO BOX 6907, DOTHAN, AL 36302
(334) 793-5000
(334) 615-8428
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
1044483
AL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
034384600
—
FL
05
—
051515739
—
AL
01
—
51515739
BCBS AL
AL
05
—
691173405B
—
GA
01
—
P00057714
RR MCARE
—
Enumeration date
03/31/2006
Last updated
07/25/2011
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