Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | ME96094 | FL |
N | 207QS0010X | Family Doctor - Sports Medicine | 96094 | FL |
NPI | 1225094972 |
---|---|
Provider Name | Dr. Ted A Farrar |
First Address | Clearwater, FL 33757-8744 |
Second Address | Clearwater, FL 33755-4254 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 02/06/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
275983700 | (05) | FL |
H08822 | (02) | KY |
P00634853 | RAILROAD MEDICARE PROVIDER NUMBER (01) | FL |