Individual
DR. EDWIN ALLEN CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
1501 ALDERSGATE RD, LITTLE ROCK, AR 72205-6611
(501) 224-1501
(501) 376-7065
Mailing address
1501 ALDERSGATE RD, LITTLE ROCK, AR 72205-6611
(501) 224-1501
(501) 376-7065
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
89
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
109956017
—
AR
01
—
480017088
RR MEDICARE
—
01
—
56081
FIRST SOURCE PPO
AR
Enumeration date
02/08/2006
Last updated
07/07/2011
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