Active NPI
Robert B Clark, MD
- Anesthesiology Physician
- Little Rock, AR
National Provider Identifier
1538123518
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Anesthesiology Physician
- License
- C5383
- Practice address
- 1701 S Shackleford Rd
Little Rock, AR 72211-4335 - Phone
- (501) 219-7481
- NPI assigned
- Apr 14, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Anesthesiology Physician | 207L00000X | C5383 | AR | Primary |
Addresses
Primary practice location
1701 S Shackleford Rd
Little Rock, AR 72211-4335
Mailing address
PO Box 65978
Charlotte, NC 28265-0978
Phone (501) 771-4693
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 102979001 | Medicaid | AR |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| C5383 | AR | MD | Anesthesiology Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1144972800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1278374400000",
"number": "1538123518",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 65978",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282650978",
"telephone_number": "501-771-4693",
"fax_number": "501-771-4885"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1701 S SHACKLEFORD RD",
"city": "LITTLE ROCK",
"state": "AR",
"postal_code": "722114335",
"telephone_number": "501-219-7481"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "ROBERT",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-04-14",
"last_updated": "2010-07-06",
"status": "A"
},
"taxonomies": [
{
"code": "207L00000X",
"taxonomy_group": "",
"desc": "Anesthesiology",
"state": "AR",
"license": "C5383",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "102979001",
"state": "AR"
}
],
"endpoints": [],
"other_names": []
}Other providers in Little Rock, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 6, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.