Charles A Clark, MD

Primary specialty

Orthopaedic Surgery PhysicianTaxonomy code 207X00000X

License

N8106 Issued in AR

Practice address

1609 W 40TH Ave
Ste 501
Pine Bluff, AR 71603-6329

Phone

(870) 534-3449

Fax

(870) 535-6730

NPI assigned

Sep 12, 2005

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1126483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1233705600000",
    "number": "1043205461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "STE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-6730"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1609 W 40TH AVE",
            "address_2": "STE 501",
            "city": "PINE BLUFF",
            "state": "AR",
            "postal_code": "716036329",
            "telephone_number": "870-534-3449",
            "fax_number": "870-535-6730"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CLARK",
        "first_name": "CHARLES",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-09-12",
        "last_updated": "2009-02-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207X00000X",
            "taxonomy_group": "",
            "desc": "Orthopaedic Surgery",
            "state": "AR",
            "license": "N8106",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "119794001",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Chelsea Briggs
• Raven Cherry, RN
• Children'S Clinic, P.a.
• Stephen Christian
• City 2 City Marketing & Distribution
• Debra Doublet Clark, PA-C
• Derwin Clark
• Michael D Clark, DDS
• Shelby Danyelle Clements, B.A
• Johnny F Clendenin Jr., CRNA

• Orthopaedic Surgery Physician in Pine Bluff, AR
• Providers in Pine Bluff, AR by specialty
• Orthopaedic Surgery Physician in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 4, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.