Provider Demographics
NPI:1174882658
Name:LEARCH, ROBERT JAMES (DO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LEARCH
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2605 KENTUCKY AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-3806
Mailing Address - Country:US
Mailing Address - Phone:270-575-5990
Mailing Address - Fax:270-442-7667
Practice Address - Street 1:2605 KENTUCKY AVE
Practice Address - Street 2:SUITE 602
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3800
Practice Address - Country:US
Practice Address - Phone:270-442-4830
Practice Address - Fax:270-442-7667
Is Sole Proprietor?:No
Enumeration Date:2012-05-03
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03770207R00000X, 207R00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100268380Medicaid