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Individual
DR. CLINTON AVERY NETHERLAND
Active
Individual
DR. CLINTON AVERY NETHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
E1883
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
135730001
—
AR
01
—
14266R
LA STATE MEDICAL LICENSE
LA
01
—
530572
MEDICARE
AR
01
—
E1883
AR MEDICAL LICENSE
AR
Enumeration date
08/10/2005
Last updated
03/07/2023
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