Provider Demographics
NPI:1710179684
Name:ROBERT CLARK MD
Entity Type:Organization
Organization Name:ROBERT CLARK MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BART
Authorized Official - Middle Name:H
Authorized Official - Last Name:DAWSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-951-2987
Mailing Address - Street 1:PO BOX 960313
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73196-0001
Mailing Address - Country:US
Mailing Address - Phone:405-951-2298
Mailing Address - Fax:405-951-2996
Practice Address - Street 1:11401 S. WESTERN
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170
Practice Address - Country:US
Practice Address - Phone:405-735-3041
Practice Address - Fax:405-735-3146
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTEGRIS AMBULATORY CARE CORP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-15
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty