Basic Information
| Provider Information | |||||||||
| NPI: | 1154394153 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ALEXANDER | ||||||||
| FirstName: | CLARENCE | ||||||||
| MiddleName: | R | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | JR. | ||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3239 | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295023239 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436797272 | ||||||||
| FaxNumber: | 8436797215 | ||||||||
| Practice Location | |||||||||
| Address1: | 800 E CHEVES ST | ||||||||
| Address2: | STE 310 | ||||||||
| City: | FLORENCE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 295062652 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8436797272 | ||||||||
| FaxNumber: | 8436797215 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2006 | ||||||||
| LastUpdateDate: | 02/08/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/08/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 16218 | SC | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | T10011 | 05 | SC | MEDICAID | 202935692007 | 01 | SC | BLUE CROSS ID NO. | OTHER | 247170098 | 01 | SC | WRK. COMP. ID NO. | OTHER |