Healthcare Provider Details

I. General information

NPI: 1114347267
Provider Name (Legal Business Name): ROBERT LEE CLARY R.N
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

2037 SULPHUR LICK ROAD
FRANKFORT OH
45628
US

IV. Provider business mailing address

2037 SULPHUR LICK RD
FRANKFORT OH
45628-9067
US

V. Phone/Fax

Practice location:
  • Phone: 740-701-7871
  • Fax:
Mailing address:
  • Phone: 740-701-7871
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number400498
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: