Clark, Robert Kenneth

Clark, Robert Kenneth is an individual health care provider with primary practice located at 11317 S Western Ave 900, Oklahoma City OK 73170-5849. He recently has only one registered license in Other Service Providers / Specialist, which is considered as his primary health care specialty. Clark, Robert Kenneth can be contacted via phone (405) 691-8855.

Contact Information

Primary practice address
11317 S Western Ave 900 Oklahoma City OK 73170-5849
Phone: (405) 691-8855
Fax: (405) 691-8891
Website:
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Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 13610 Oklahoma

Profile Details

NPI number 1376530600
LBN Legal business name Clark, Robert Kenneth
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 3rd, 2005
Last updated Jan 20th, 2010 - about 16 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1376530600 NPPES
Oklahoma MEDICAID 100060770B

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