Provider Demographics
NPI:1780792267
Name:WUBBEN, ROBERT CLEMENT (MD)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:CLEMENT
Last Name:WUBBEN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 8003
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54912-8003
Mailing Address - Country:US
Mailing Address - Phone:920-996-3200
Mailing Address - Fax:920-725-6535
Practice Address - Street 1:1516 S COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:NEENAH
Practice Address - State:WI
Practice Address - Zip Code:54956-4802
Practice Address - Country:US
Practice Address - Phone:920-725-0077
Practice Address - Fax:920-725-6535
Is Sole Proprietor?:No
Enumeration Date:2006-08-26
Last Update Date:2013-09-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WI23907207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI711290236OtherMEDICARE PTAN
WI30663700Medicaid
WI450030841OtherMEDICARE PTAN
WI711290236OtherMEDICARE PTAN
WI450030841OtherMEDICARE PTAN