Provider Demographics
NPI:1588641518
Name:MACE, ROBERT MORGAN (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MORGAN
Last Name:MACE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:324 MILLER MOUNTAIN DR
Mailing Address - Street 2:P.O. BOX 312
Mailing Address - City:WEBSTER SPRINGS
Mailing Address - State:WV
Mailing Address - Zip Code:26288-1065
Mailing Address - Country:US
Mailing Address - Phone:304-847-5682
Mailing Address - Fax:304-847-5985
Practice Address - Street 1:324 MILLER MOUNTAIN DR
Practice Address - Street 2:
Practice Address - City:WEBSTER SPRINGS
Practice Address - State:WV
Practice Address - Zip Code:26288-1026
Practice Address - Country:US
Practice Address - Phone:304-847-5682
Practice Address - Fax:304-847-5985
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2013-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV09250207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0055601000Medicaid
WVA71842Medicare UPIN