Dr. Robert Edward Clark
Internist Gastroenterologist
1302 Franklin Ave Suite 4800
Normal
, Illinois 61761-3551
Dr. Robert Edward Clark
Internist Gastroenterologist
1302 Franklin Ave Suite 4800
Normal
, Illinois 61761-3551
(309) 454-2820
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About
Features
Specialties
- Internist
- Gastroenterologist
Languages spoken
- English
Location
First Address
- Dr. Robert Edward Clark
- 1302 Franklin Ave Suite 4800
- Normal, IL
- Zip : 61761-3551
- Fax : (309) 454-2820
- Phone : (309) 454-5900
Second Address
- Dr. Robert Edward Clark
- 1302 Franklin Ave Suite 4800
- Normal, IL
- Zip : 61761-3551
- Fax : (309) 454-2820
- Phone : (309) 454-5900
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Scope of Practice
| Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
|---|---|---|---|---|
| N | 207R00000X | Internist | MT190170 | PA |
| N | 111NI0900X | Internist | MT190170 | PA |
| Y | 207RG0100X | Gastroenterologist | 036131371 | IL |
| N | 207RG0100X | Gastroenterologist | 2010017443 | MO |
National Provider Identifier
| NPI | 1033372727 |
|---|---|
| Provider Name | Dr. Robert Edward Clark |
| First Address | Normal, IL 61761-3551 |
| Second Address | Normal, IL 61761-3551 |
| Gender | M |
| NPI Entity type | Individual |
| Is Sole Proprietor | No |
| Is Organization Subpart | N/A |
| Enumeration Date | 03/07/2008 |
| Last Update Date | 18/06/2013 |
NPI Footnotes
What is the National Provider Identifier (NPI)
Provider Location Address
Provider Mailing Address
Entity Type Code
1= Person: individual human being who furnishes health care;
2= Non-person: entity other than an individual human being that furnishes health care (Examples: hospital, SNF, hospital subunit, pharmacy, or HMO)
What is a Subpart?
Provider Other Organization Name
1 = former name;
2 = professional name;
3 = doinq business as (d/b/ a) name;
4 = former legal business name;
5 = other.