Provider Demographics
NPI:1710962535
Name:FARMER, WILLIAM ROY (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:ROY
Last Name:FARMER
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 1:101 MONTESANO DR
Mailing Address - Street 2:
Mailing Address - City:EVERGREEN
Mailing Address - State:AL
Mailing Address - Zip Code:36401-2610
Mailing Address - Country:US
Mailing Address - Phone:251-578-1382
Mailing Address - Fax:
Practice Address - Street 1:101 CRESTVIEW AVE
Practice Address - Street 2:
Practice Address - City:EVERGREEN
Practice Address - State:AL
Practice Address - Zip Code:36401-3333
Practice Address - Country:US
Practice Address - Phone:251-578-2480
Practice Address - Fax:251-578-1055
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD10163207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051504817Medicaid
AL009914204Medicaid
AL51009683OtherBCBS PROVIDER
ALC73323Medicare UPIN
AL51009683OtherBCBS PROVIDER