Provider Demographics
NPI:1487704375
Name:CLAPP, ROGER C JR (MD)
Entity type:Individual
Prefix:
First Name:ROGER
Middle Name:C
Last Name:CLAPP
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 DOCTORS PARK
Mailing Address - Street 2:
Mailing Address - City:STARKVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39759-2174
Mailing Address - Country:US
Mailing Address - Phone:662-324-1310
Mailing Address - Fax:662-324-7148
Practice Address - Street 1:105 DOCTORS PARK
Practice Address - Street 2:
Practice Address - City:STARKVILLE
Practice Address - State:MS
Practice Address - Zip Code:39759-2174
Practice Address - Country:US
Practice Address - Phone:662-324-1310
Practice Address - Fax:662-324-7148
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-11
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS16439208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00121176Medicaid
MS020000359Medicare ID - Type Unspecified
MS00121176Medicaid