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General NPI Number Information
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NPI Number | 1245279868
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Entity Type | Individual
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Provider Name | E CLARKE ROBERTS PA
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Gender | Male
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Dates
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Enumeration Date | 06/06/2006
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Last Update Date | 11/08/2013
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Provider Practice Location Address
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Address Line | 360 W CENTRAL AVE
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City | SPRINGBORO
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State | OH
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Zip | 45066-1106
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Country | US
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Telephone | 937-208-7100
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Fax | 937-208-7125
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Provider Business Mailing Address
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Address Line | 360 W CENTRAL AVE
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City | SPRINGBORO
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State | OH
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Zip | 45066-1106
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Country | US
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Telephone | 937-208-7100
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Fax | 937-208-7125
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 50-000247
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License Number State | OH
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