Provider Demographics
NPI:1861494478
Name:SECOR, ROBERT W (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:W
Last Name:SECOR
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:885 N SANDUSKY AVE
Mailing Address - Street 2:
Mailing Address - City:UPPER SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:43351-1098
Mailing Address - Country:US
Mailing Address - Phone:419-294-4991
Mailing Address - Fax:419-209-0278
Practice Address - Street 1:103 N PENNINGTON ST
Practice Address - Street 2:
Practice Address - City:SYCAMORE
Practice Address - State:OH
Practice Address - Zip Code:44882-9408
Practice Address - Country:US
Practice Address - Phone:419-927-6552
Practice Address - Fax:419-933-4502
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2020-12-15
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OH35057598207Q00000X
OH35.057598207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0799300Medicaid
OH700006733OtherRR MEDICARE
OH700006733OtherRR MEDICARE
OHF13530Medicare UPIN