Individual
DR. TERESA CLARK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1200 W WALNUT ST, ROGERS, AR 72756-3546
(479) 636-0200
Mailing address
PO BOX 634706, CINCINNATI, OH 45263-0001
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
E-1370
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
133747001
—
AR
05
—
205182900
—
MO
01
—
5K667
BLUE CROSS
AR
Enumeration date
06/05/2006
Last updated
10/28/2022
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