Provider Demographics
NPI:1265632368
Name:CLARK, JOSHUA A (MD)
Entity Type:Individual
Prefix:
First Name:JOSHUA
Middle Name:A
Last Name:CLARK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11808 HIGHWAY 71 S
Mailing Address - Street 2:
Mailing Address - City:FORT SMITH
Mailing Address - State:AR
Mailing Address - Zip Code:72916-9378
Mailing Address - Country:US
Mailing Address - Phone:479-434-6140
Mailing Address - Fax:479-434-6144
Practice Address - Street 1:11808 HIGHWAY 71 S
Practice Address - Street 2:
Practice Address - City:FORT SMITH
Practice Address - State:AR
Practice Address - Zip Code:72916-9378
Practice Address - Country:US
Practice Address - Phone:479-434-6140
Practice Address - Fax:479-434-6144
Is Sole Proprietor?:No
Enumeration Date:2007-07-18
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
ARE-5920207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200231900AMedicaid
AR440163301OtherARKANSAS MEDICAID TEMP. R
AR5H862Medicare PIN