Provider Demographics
NPI:1649206210
Name:FARRAR, GAIL I (MD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:FARRAR
Suffix:I
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:GAIL
Other - Middle Name:
Other - Last Name:FARRAR
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1800 BEACH DR
Mailing Address - Street 2:
Mailing Address - City:GULFPORT
Mailing Address - State:MS
Mailing Address - Zip Code:39507-1553
Mailing Address - Country:US
Mailing Address - Phone:228-897-4450
Mailing Address - Fax:228-897-4497
Practice Address - Street 1:1800 BEACH DR
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39507-1553
Practice Address - Country:US
Practice Address - Phone:228-897-4450
Practice Address - Fax:228-897-4497
Is Sole Proprietor?:No
Enumeration Date:2006-06-24
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS10225207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00112512Medicaid
MS110129721OtherRAILROAD MEDICARE
MS$$$$$$$$$COtherBCBS
MS00112512Medicaid
MS110129721OtherRAILROAD MEDICARE
MS110000607Medicare ID - Type Unspecified
MS302I115947Medicare PIN
MSE86656Medicare UPIN
MSP00651254Medicare PIN