Healthcare Provider Details

I. General information

NPI: 1619801321
Provider Name (Legal Business Name): MR. CLINTON BOBRAY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 N 1ST ST
NEWARK OH
43055-5608
US

IV. Provider business mailing address

40 HUTCHINSON AVE APT 226
COLUMBUS OH
43235-4761
US

V. Phone/Fax

Practice location:
  • Phone: 614-844-3800
  • Fax:
Mailing address:
  • Phone: 614-844-3800
  • Fax: 614-844-3800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: