Provider Demographics
NPI:1518979293
Name:CLOTHIER, JEFFREY LANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:LANE
Last Name:CLOTHIER
Suffix:
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 1:4 BLACK BEAR CT
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72223-5205
Mailing Address - Country:US
Mailing Address - Phone:501-257-3094
Mailing Address - Fax:501-257-3110
Practice Address - Street 1:4300 W 7TH ST
Practice Address - Street 2:116T/LR
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72205-5446
Practice Address - Country:US
Practice Address - Phone:501-257-3094
Practice Address - Fax:501-257-3110
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARR-41872084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
54400Medicare ID - Type Unspecified
C14557Medicare UPIN