Provider Demographics
NPI:1578712832
Name:CLAGUE, ROBERT MICHAEL (PAC)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:MICHAEL
Last Name:CLAGUE
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1717 MAIN ST
Mailing Address - Street 2:SUITE 5200
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75201-4612
Mailing Address - Country:US
Mailing Address - Phone:214-712-2489
Mailing Address - Fax:214-712-2444
Practice Address - Street 1:1650 W COLLEGE ST
Practice Address - Street 2:
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-3565
Practice Address - Country:US
Practice Address - Phone:817-488-7546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2008-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02602363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant