Provider Demographics
NPI:1316931256
Name:VARNER, CLYDE R (MD)
Entity type:Individual
Prefix:DR
First Name:CLYDE
Middle Name:R
Last Name:VARNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 10880
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86304-0880
Mailing Address - Country:US
Mailing Address - Phone:928-759-5874
Mailing Address - Fax:928-458-2039
Practice Address - Street 1:820 AINSWORTH DR
Practice Address - Street 2:SUITE A
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86301-1613
Practice Address - Country:US
Practice Address - Phone:928-778-0827
Practice Address - Fax:928-778-5622
Is Sole Proprietor?:No
Enumeration Date:2005-09-07
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ420612084V0102X, 2084N0400X
AL99812084N0400X
LA08710R2084N0400X
OK389482084V0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology
No2084V0102XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyVascular Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA0101241480OtherLICENSE
OK201051630AMedicaid
AL51545992OtherBCBS- 3401 MEDICAL PK DR
AL009913762Medicaid
AL51547299OtherBCBS - 575 STANTON RD
MS09429053Medicaid
AL101165Medicaid
MS09429053Medicaid
MS09429053Medicaid