Provider Demographics
NPI:1174569578
Name:FARRAR, ELIZABETH VEREEN (MD)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:VEREEN
Last Name:FARRAR
Suffix:
Gender:F
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:PO BOX 5183
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-5183
Mailing Address - Country:US
Mailing Address - Phone:601-703-4282
Mailing Address - Fax:601-703-4597
Practice Address - Street 1:2800 N HILLS ST
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39305-2643
Practice Address - Country:US
Practice Address - Phone:601-693-9906
Practice Address - Fax:601-484-6704
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19326207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS08379802Medicaid
MSP00326409OtherRR MEDICARE
H63565Medicare UPIN
MS080004261Medicare PIN