Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Fair Park Medical Clinic

Organization Internal Medicine Physician · NPI 1740481191

Fair Park Medical Clinic is an Internal Medicine Physician in Little Rock, Arkansas. Licensed in Arkansas. Registered with an NPI since 2007.

Licensed in
AR
In the registry since
2007

Practice location Address checks out

5320 W 12th St
Little Rock, AR 72204-1859
Phone: (501) 663-6262
Fax: (501) 663-3189
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Internal Medicine Physician (primary) Taxonomy 207R00000X · Licence MC2208 (AR)

Record details

NPI number1740481191
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Carl Johnson — Owner · (501) 663-6262
Other names Fair Park Medical Clinic
NPI enumeratedMay 31, 2007
Last updated in NPPESAugust 22, 2020
Mailing address5320 W. 12th Street, Little Rock, AR 72206

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