Healthcare Provider Details

I. General information

NPI: 1700945458
Provider Name (Legal Business Name): ROBERT D. CLEMONS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/08/2006
Last Update Date: 09/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

IV. Provider business mailing address

4647 ZION AVE
SAN DIEGO CA
92120-2507
US

V. Phone/Fax

Practice location:
  • Phone: 619-528-5000
  • Fax:
Mailing address:
  • Phone: 619-528-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0205X
TaxonomyPediatric Endocrinology Physician
License NumberG20960
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: