Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223P0221X | Pediatric Dentist | 3385 | OK |
NPI | 1063699650 |
---|---|
Provider Name | Dr. Barry J Farmer |
First Address | Muskogee, OK 74403-3863 |
Second Address | Muskogee, OK 74403-3863 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 25/01/2008 |