Provider Demographics
NPI:1043232325
Name:CLARK, ROBERT ALEXANDER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:955 DEEP VALLEY DR
Mailing Address - Street 2:#2950
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3058
Mailing Address - Country:US
Mailing Address - Phone:310-707-8113
Mailing Address - Fax:562-595-7639
Practice Address - Street 1:4401 ATLANTIC AVE STE 410
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-2263
Practice Address - Country:US
Practice Address - Phone:562-459-3363
Practice Address - Fax:562-459-3364
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG080142207W00000X
CAG80142207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
A37654Medicare UPIN