Individual
DR. CLINTON AVERY NETHERLAND
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 PERSHING HWY, SMACKOVER, AR 71762-2300
(870) 725-3471
(870) 725-3471
Mailing address
1400 PERSHING HWY, SMACKOVER, AR 71762-2300
(870) 725-3471
(870) 725-3041
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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