MEDICARE: DR. ROBERT DALE CLARK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	0098-01210	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1376542597
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT DALE CLARK M.D.

Provider Business Mailing Address
First Line	:	PO BOX 58
Second Line	:
City	:	CROSSNORE
State	:	NC
Zip	:	28616-0058
Country	:	US
Telephone Number	:	828-528-1168
Fax Number	:

Provider Business Practice Location Address
First Line	:	137 NOTALEE ST
Second Line	:
City	:	NEWLAND
State	:	NC
Zip	:	28657
Country	:	US
Telephone Number	:	828-528-3009
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2005
Last Update Date	:	08/20/2018

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