Healthcare Provider Details

I. General information

NPI: 1548963937
Provider Name (Legal Business Name): MICHAEL ALEJANDRO CLARK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/23/2023
Last Update Date: 07/21/2026
Certification Date: 07/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3201 SPRINGHILL DR STE 100
NORTH LITTLE ROCK AR
72117-2905
US

IV. Provider business mailing address

2400 S AVENUE A
YUMA AZ
85364-7127
US

V. Phone/Fax

Practice location:
  • Phone: 501-955-4530
  • Fax:
Mailing address:
  • Phone: 928-336-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number80590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: