Provider Demographics
NPI:1811944804
Name:RORRER, CLYDE (DO)
Entity type:Individual
Prefix:
First Name:CLYDE
Middle Name:
Last Name:RORRER
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 1:90 JACKSON PIKE
Mailing Address - Street 2:
Mailing Address - City:GALLIPOLIS
Mailing Address - State:OH
Mailing Address - Zip Code:45631-1560
Mailing Address - Country:US
Mailing Address - Phone:740-446-5201
Mailing Address - Fax:740-446-5761
Practice Address - Street 1:90 JACKSON PIKE
Practice Address - Street 2:
Practice Address - City:GALLIPOLIS
Practice Address - State:OH
Practice Address - Zip Code:45631-1560
Practice Address - Country:US
Practice Address - Phone:740-446-5201
Practice Address - Fax:740-446-5761
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.006789207P00000X
WV1297207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV001721692OtherBLUE CROSS BLUE SHIELD
WV0043582000Medicaid
WV3001158OtherWORKERS COMPENSATION
KY6404532100Medicaid
OH0848024Medicaid
WVF10797Medicare UPIN
KY6404532100Medicaid
WV0729859Medicare PIN