Healthcare Provider Details

I. General information

NPI: 1326038035
Provider Name (Legal Business Name): DOUGLAS A. CLARK P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 05/06/2025
Certification Date: 05/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9601 BAPTIST HEALTH DR STE 860
LITTLE ROCK AR
72205-6375
US

IV. Provider business mailing address

4261 STOCKTON DRIVE SUITE LL100
NORTH LITTLE ROCK AR
72117-2962
US

V. Phone/Fax

Practice location:
  • Phone: 501-975-7455
  • Fax: 501-975-3631
Mailing address:
  • Phone: 501-975-7456
  • Fax: 501-978-1822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: