Individual
DR. CHARLES A CLARK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1609 W 40TH AVE, STE 501, PINE BLUFF, AR 71603-6329
(870) 534-3449
(870) 535-6730
Mailing address
1609 W 40TH AVE, STE 501, PINE BLUFF, AR 71603-6329
(870) 534-3449
(870) 535-6730
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
N8106
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
119794001
—
AR
Enumeration date
09/12/2005
Last updated
02/04/2009
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