Provider Demographics
NPI:1407856958
Name:FARMER, CLARANCE STEPHEN II (MD)
Entity Type:Individual
Prefix:DR
First Name:CLARANCE
Middle Name:STEPHEN
Last Name:FARMER
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:PO BOX 829
Mailing Address - Street 2:
Mailing Address - City:TUPELO
Mailing Address - State:MS
Mailing Address - Zip Code:38802-0829
Mailing Address - Country:US
Mailing Address - Phone:662-377-7100
Mailing Address - Fax:662-377-7115
Practice Address - Street 1:499 GLOSTER CREEK VLG
Practice Address - Street 2:SUITE A1
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38801-4600
Practice Address - Country:US
Practice Address - Phone:662-377-7100
Practice Address - Fax:662-377-7115
Is Sole Proprietor?:No
Enumeration Date:2005-07-27
Last Update Date:2016-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS12111208800000X
AL21398208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL009804010Medicaid
110150782OtherRR MEDICARE
MS00118038Medicaid
MS340000156Medicare ID - Type Unspecified
AL009804010Medicaid
AL000058847Medicare ID - Type Unspecified