Provider Demographics
NPI:1225032618
Name:MCNAB, ROBERT CYRIL (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CYRIL
Last Name:MCNAB
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3810
Mailing Address - Street 2:
Mailing Address - City:JOPLIN
Mailing Address - State:MO
Mailing Address - Zip Code:64803-3810
Mailing Address - Country:US
Mailing Address - Phone:417-347-1095
Mailing Address - Fax:
Practice Address - Street 1:1102 W 32ND ST
Practice Address - Street 2:
Practice Address - City:JOPLIN
Practice Address - State:MO
Practice Address - Zip Code:64804-3503
Practice Address - Country:US
Practice Address - Phone:417-347-1095
Practice Address - Fax:417-347-5424
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005005293207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO207298605Medicaid
KS200329990AMedicaid
MO35371011OtherBLUE SHIELD KANSAS CITY
MO7163639OtherAETNA
MO7163639OtherAETNA
MO35371011OtherBLUE SHIELD KANSAS CITY
MOM78D819Medicare PIN