Provider Demographics
NPI:1952453151
Name:POE, ROBERT WAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:WAYNE
Last Name:POE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:320 S COMMERCIAL ST UNIT 2090
Mailing Address - Street 2:
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9998
Mailing Address - Country:US
Mailing Address - Phone:417-213-9654
Mailing Address - Fax:417-215-8055
Practice Address - Street 1:915 STATE HIGHWAY 248 STE B
Practice Address - Street 2:
Practice Address - City:BRANSON
Practice Address - State:MO
Practice Address - Zip Code:65616-8004
Practice Address - Country:US
Practice Address - Phone:417-213-9654
Practice Address - Fax:417-215-8055
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2023032112207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC68323OtherBLUE CROSS BLUE SHIELD
NC6968323Medicaid
NC129628OtherWELLPATH INSURANCE
NC31616OtherSTATE MEDICAL LICENSE NUM
NC5440587OtherAETNA
NCC82200Medicare UPIN
NC6968323Medicaid