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General NPI Number Information
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NPI Number | 1376029041
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Entity Type | Organization
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Legal Business Name | MICHAEL S. CLARKE, M.D., P.A.
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Dates
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Enumeration Date | 07/16/2018
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Last Update Date | 10/26/2018
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Provider Practice Location Address
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Address Line | 620 N MAIN ST
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City | HARRISON
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State | AR
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Zip | 72601-2911
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Country | US
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Telephone | 870-414-4073
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3317
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City | HARRISON
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State | AR
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Zip | 72602-3317
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Country | US
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Telephone | 870-414-4073
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Fax | 870-414-4984
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Authorized Official
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Title or Position | PATHOLOGIST
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Name | DR. MICHAEL SYDENHAM CLARKE
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Credential | MD
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Telephone | 870-414-4073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207ZP0102X
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Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
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License Number | E-11363
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License Number State | AR
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