Provider Demographics
NPI:1235222928
Name:CLINTON, ROBERT ALLEN JR (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ALLEN
Last Name:CLINTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:420 OWEN DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28304-3430
Mailing Address - Country:US
Mailing Address - Phone:910-484-1210
Mailing Address - Fax:910-484-1347
Practice Address - Street 1:420 OWEN DR
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3430
Practice Address - Country:US
Practice Address - Phone:910-484-1210
Practice Address - Fax:910-484-1347
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NC2005-00848207N00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIH18844Medicare UPIN