Basic Information
| Provider Information | |||||||||
| NPI: | 1558374850 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FARMER | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | |||||||||
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| Credential: | D.O. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9 E CADBURY LN | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394025518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6015963632 | ||||||||
| FaxNumber: | 6012685185 | ||||||||
| Practice Location | |||||||||
| Address1: | 100 METHODIST BLVD | ||||||||
| Address2: | |||||||||
| City: | HATTIESBURG | ||||||||
| State: | MS | ||||||||
| PostalCode: | 394021295 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6012685185 | ||||||||
| FaxNumber: | 6012685185 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 09/14/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RG0100X | 18326 | MS | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology |
ID Information
| ID | Type | State | Issuer | Description | 0959507 | 05 | MS | MEDICAID | 9966765 | 05 | AL | MEDICAID |