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Individual

DR. TERRY L CLARK

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
4300 REGIONS PARK DR, FORT SMITH, AR 72916-9373
(479) 274-6300
(479) 484-4715
Mailing address
PO BOX 3528, FORT SMITH, AR 72913-3528
(479) 274-2000
(479) 274-2194

Taxonomy

Speciality
Code
Description
License number
State
2083X0100X
Occupational Medicine Physician
Primary
R-3194
AR

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
080101199
RR MEDICARE
05
111575001
AR
Enumeration date
07/03/2006
Last updated
08/28/2015
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