Healthcare Provider Details

I. General information

NPI: 1629114137
Provider Name (Legal Business Name): ROBERT CLAYTON JARCHOW MEDICAL DOCTOR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 04/16/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1018 LEE ANN DR NE
CONCORD NC
28025-2911
US

IV. Provider business mailing address

1018 LEE ANN DR NE
CONCORD NC
28025-2911
US

V. Phone/Fax

Practice location:
  • Phone: 704-782-7111
  • Fax: 704-782-7139
Mailing address:
  • Phone: 704-782-7111
  • Fax: 704-782-7139

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License Number39284
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: