Provider Demographics
NPI:1952630089
Name:CHAPMAN, CLYDE ROZELL II (MD)
Entity Type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:ROZELL
Last Name:CHAPMAN
Suffix:II
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3648 JONES LOOP
Mailing Address - Street 2:
Mailing Address - City:TERRY
Mailing Address - State:MS
Mailing Address - Zip Code:39170-9248
Mailing Address - Country:US
Mailing Address - Phone:601-462-3532
Mailing Address - Fax:
Practice Address - Street 1:17280 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-6614
Practice Address - Country:US
Practice Address - Phone:662-834-1857
Practice Address - Fax:662-834-1859
Is Sole Proprietor?:No
Enumeration Date:2009-12-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036.124688208000000X
MS22207208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics