Healthcare Provider Details

I. General information

NPI: 1679570287
Provider Name (Legal Business Name): ROBERT GORDON MARSH ARNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2005
Last Update Date: 12/27/2019
Certification Date: 12/27/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1059 BARTON DR
FORDLAND MO
65652-7350
US

IV. Provider business mailing address

718 PATTERSON RD
ROGERSVILLE MO
65742-8096
US

V. Phone/Fax

Practice location:
  • Phone: 417-767-2273
  • Fax: 417-767-4054
Mailing address:
  • Phone: 417-753-7084
  • Fax: 417-767-4054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberARNP 938462
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberRN105886
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License NumberARNP 938462
License Number StateFL
# 4
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN 105886
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: