Provider Demographics
NPI:1811983356
Name:DARNABY, ROBERT ELLIS (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIS
Last Name:DARNABY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4699
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47903-4699
Mailing Address - Country:US
Mailing Address - Phone:765-449-2732
Mailing Address - Fax:765-449-1196
Practice Address - Street 1:124 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:RENSSELAER
Practice Address - State:IN
Practice Address - Zip Code:47978-2820
Practice Address - Country:US
Practice Address - Phone:219-866-4135
Practice Address - Fax:219-866-0803
Is Sole Proprietor?:No
Enumeration Date:2005-09-20
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INA01028943207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100142840AMedicaid
IN100142840Medicaid
IN080001859OtherPALMETTO GBA
IN390700Medicare ID - Type Unspecified
IN100142840AMedicaid
INP01004607Medicare PIN