# DR. CLINTON AVERY NETHERLAND

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1235130444
- **Gender:** Man
- **Credential:** M.D.

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | E1883 | AR | Yes |

## Other

- **Enumeration date:** 08/10/2005
- **Last updated:** 03/07/2023

## 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 |