Provider Demographics
NPI:1639143472
Name:CLEMENTS, ROBERT CARTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CARTER
Last Name:CLEMENTS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:R
Other - Middle Name:CARTER
Other - Last Name:CLEMENTS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1459 HUMBOLDT RD STE A
Mailing Address - Street 2:
Mailing Address - City:CHICO
Mailing Address - State:CA
Mailing Address - Zip Code:95928-9100
Mailing Address - Country:US
Mailing Address - Phone:530-855-0213
Mailing Address - Fax:530-466-3741
Practice Address - Street 1:1459 HUMBOLDT RD STE A
Practice Address - Street 2:
Practice Address - City:CHICO
Practice Address - State:CA
Practice Address - Zip Code:95928-9100
Practice Address - Country:US
Practice Address - Phone:530-855-0213
Practice Address - Fax:530-466-3741
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-16
Last Update Date:2023-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41716207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A417160Medicaid
CA00A417160Medicare ID - Type Unspecified
E75954Medicare UPIN