Provider Demographics
NPI:1780824490
Name:CLARKE, ROBIN MICHAEL ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:ROBIN
Middle Name:MICHAEL ANTHONY
Last Name:CLARKE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:UCLA MEDICAL CTR
Mailing Address - Street 2:757 WESTWOOD PLAZA
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-206-6766
Mailing Address - Fax:310-794-2113
Practice Address - Street 1:200 MEDICAL PLZ
Practice Address - Street 2:420
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-6766
Practice Address - Fax:310-794-2113
Is Sole Proprietor?:No
Enumeration Date:2009-02-20
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA106915207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1780824490OtherCCS PANELED
CA1780824490Medicaid
CA1780824490Medicaid