Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223D0004X | Dentist Anesthesiologist | D008883 | AZ |
NPI | 1962785097 |
---|---|
Provider Name | Bradley L Farr |
First Address | Mesa, AZ 85210-5030 |
Second Address | Mesa, AZ 85210-5030 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2011 |
Last Update Date | 28/06/2016 |