Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Y00000X | Otolaryngologist (ENT Doctor) | M5806 | ID |
NPI | 1033116322 |
---|---|
Provider Name | Dr. Robert C. Farr |
First Address | Coeur D Alene, ID 83814-4484 |
Second Address | Coeur D Alene, ID 83814-4484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/07/2005 |
Last Update Date | 26/04/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000010006074 | REGENCE BLUE SHIELD OF ID (01) | |
0083130 | (05) | MT |
58065 | BLUE CROSS OF IDAHO (01) | |
8409252 | (05) | WA |
E92522 | (02) |