Provider Demographics
NPI:1184605271
Name:ADAMS, ROBERT CLARK (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:CLARK
Last Name:ADAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1178 PROFESSIONAL DR
Mailing Address - Street 2:
Mailing Address - City:VAN WERT
Mailing Address - State:OH
Mailing Address - Zip Code:45891-2461
Mailing Address - Country:US
Mailing Address - Phone:419-238-6251
Mailing Address - Fax:419-238-1652
Practice Address - Street 1:1178 PROFESSIONAL DR
Practice Address - Street 2:
Practice Address - City:VAN WERT
Practice Address - State:OH
Practice Address - Zip Code:45891-2461
Practice Address - Country:US
Practice Address - Phone:419-238-6251
Practice Address - Fax:419-238-1652
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2021-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35039696207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0392730Medicaid
OH080012545OtherRR MEDICARE
OH0559360001Medicare NSC
OH0392730Medicaid
OHA14943Medicare UPIN