Provider Demographics
NPI:1679570287
Name:MARSH, ROBERT GORDON (ARNP)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:GORDON
Last Name:MARSH
Suffix:
Gender:M
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:718 PATTERSON RD
Mailing Address - Street 2:
Mailing Address - City:ROGERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:65742-8096
Mailing Address - Country:US
Mailing Address - Phone:417-753-7084
Mailing Address - Fax:417-767-4054
Practice Address - Street 1:1059 BARTON DR
Practice Address - Street 2:
Practice Address - City:FORDLAND
Practice Address - State:MO
Practice Address - Zip Code:65652-7350
Practice Address - Country:US
Practice Address - Phone:417-767-2273
Practice Address - Fax:417-767-4054
Is Sole Proprietor?:No
Enumeration Date:2005-06-29
Last Update Date:2019-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP 938462363LF0000X, 363LG0600X
MORN105886363LG0600X
MORN 105886363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO428189617Medicaid
S15111Medicare UPIN
MO428189617Medicaid