Provider Demographics
NPI:1811590102
Name:FIELDS, ROBERT L JR
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:FIELDS
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1567 STADELMAN AVE
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44320-1765
Mailing Address - Country:US
Mailing Address - Phone:330-962-5881
Mailing Address - Fax:
Practice Address - Street 1:1567 STADELMAN AVE
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44320-1765
Practice Address - Country:US
Practice Address - Phone:330-962-5881
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-18
Last Update Date:2020-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC104860316172A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver