Provider Demographics
NPI:1154383289
Name:CLINTON, GILBERT N II (MD)
Entity type:Individual
Prefix:
First Name:GILBERT
Middle Name:N
Last Name:CLINTON
Suffix:II
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 1:202 EAGLE ROCK BND
Mailing Address - Street 2:
Mailing Address - City:MILLBROOK
Mailing Address - State:AL
Mailing Address - Zip Code:36054-1773
Mailing Address - Country:US
Mailing Address - Phone:501-258-1175
Mailing Address - Fax:
Practice Address - Street 1:1 MEDICAL PARK DR
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3353
Practice Address - Country:US
Practice Address - Phone:501-776-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-04
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME134699207L00000X
ARE0807207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
5K389OtherAR BCBS
P00307561OtherRR MEDICARE GROUP CK6327
AR136439001Medicaid
G59412Medicare UPIN
AR5K389C752Medicare PIN
AR5K389Medicare PIN